Depression and coronary heart disease:: Complex synergism of mind, body, and environment

Beyond depression's impact on life quality, it is associated with both the incidence of coronary heart disease (CHD) and its prognosis. Depression is three times more common in CHD patients than in the general community. It is independently associated with at least a doubling in risk of subsequent cardiac events. Studies also show that it may precede the development of clinically evident CHD by many years. The mechanisms linking depression. and CHD are currently unknown and likely to be complex. In addition to behavioral factors, changes in autonomic regulation., vascular disease of the brain, subchronic inflammation, reduced omega-3 free fatty acid levels, and enhanced platelet responsiveness may all be involved. Only one large clinical trial has attempted to alter CHD prognosis by treating depression. It succeeded in producing a small, but significant reduction in depression symptoms, but had no impact on subsequent CHD events. While debate continues about the causal relationship between CHD and depression, the best treatment strategy to improve prognosis in depressed CHD patients remains intensive modification of standard CHD risk factors in, combination with treatment of depression to improve life quality.