Effects of depressive disorders on coronary artery disease: a review.

Evidence suggests that major depression and ischemic heart disease commonly co-occur and that depressive symptoms have a negative impact on cardiovascular prognosis. A Medline search was conducted to obtain articles published between 1966 and 1996 that address the association between depressive disorders and coronary artery disease. We used systematic epidemiologic criteria to examine the strength of this association. There is convincing evidence that in patients with coronary artery disease, depressive disorders are common and are associated with increased rates of morbidity and mortality. Several biological mechanisms have been proposed to explain the association, including alterations in autonomic function leading to increased risk of ventricular arrhythmias. Despite the evidence that their comorbid presence is associated with increased morbidity and mortality, depressive disorders in patients with coronary artery disease are often underdiagnosed and inadequately treated. At the very least, randomized treatment trials are indicated.