Treating the depressed patient with cardiovascular problems.

A multidimensional relationship exists between cardiovascular disease and affective disorder that includes the observations that (1) there is a high rate of depression in the postmyocardial infarction period, (2) the presence of depressive illness adversely affects the prognosis of cardiac disease, and (3) depressed patients have a higher-than-expected rate of sudden cardiovascular death. The authors discuss these topics and the clinical management of depression in patients with significant preexisting heart disease. The cardiovascular effects of the tricyclic antidepressants and recently introduced nontricyclic antidepressants are reviewed with a focus on how the clinician can safely and effectively treat affective disorder in patients with severe cardiac disease.