This article reviews the burgeoning literature on the relationship of mood disorders and heart disease. Major depression and depressive symptoms, although commonly encountered in medical populations, are frequently underdiagnosed and undertreated in patients with cardiovascular disease (CVD). This is of particular importance because several studies have shown depression and its associated symptoms to be a major risk factor for both the development of CVD and death after an index myocardial infarction. This review of the extant literature is derived from MEDLINE searches (1966-1997) using the search terms "major depression," "psychiatry," "cardiovascular disease," and "pathophysiology." Studies investigating pathophysiological alterations related to CVD in depressed patients are reviewed. The few studies on treatment of depression in patients with CVD are also described. Treatment of depression in patients with CVD improves their dysphoria and other signs and symptoms of depression, improves quality of life, and perhaps even increases longevity. Recommendations for future research are proposed.
Hypothetical schema of pathophysiologic alterations associated with depression that likely contribute to increased vulnerability to cardiovascular disease (CVD). Autonomic nervous system innervation of the heart via parasympathetic vagus (X) and sympathetic (postganglionic efferents from cervical and upper thoracic paravertebral ganglia) nerves is shown. CRF indicates corticotropin-releasing factor; ACTH, corticotropin; TNF-α, tumor necrosis factor α; IL-1, interleukin 1; IL-6, interleukin-6; HRV, heart rate variability; and HPA, hypothalamic-pituitary-adrenocortical axis.
Platelet adhesion to collagen exposed within the denuded area of vascular endothelium has stimulated platelet activation. Activation is accompanied by extrusion of platelet storage granule contents, which recruits other platelets, causes irreversible platelet-platelet aggregation, and forms a fused platelet thrombus. Ca++ indicates intracellular free calcium concentrations; PF4, platelet factor 4; β-TG, β-thromboglobulin; ADP, adenosine diphosphate; and 5HT, serotonin. Adapted from R&D Systems, Minneapolis, Minn. Used with permission.
Thank you for submitting a comment on this article. It will be reviewed by JAMA Psychiatry editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 783
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
The Rational Clinical Examination EDUCATION GUIDES
All results at
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.