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Depression and heart disease have an intricate association and perhaps a causal relationship. We review the current status of depression and heart disease and provide an algorithm for diagnosing and treating depression in cardiac patients that internists and cardiologists can use in their daily patient encounters.

Objective-Research on the relationship of depression to mortality has yielded mixed results. Limitations of previous studies include mostly one-time assessment of depression, short follow-ups, and failure to model changes in depression appropriately. We attempted to use a joint modeling approach to examining the association between longitudinal changes in depressive symptoms and mortality.Methods-Data were obtained from the Florida Retirement Study, a prospective cohort study of community-dwelling oldest old individuals. At baseline, 879 people (M age = 80.6, 65.8% women) had comprehensive psychosocial assessment, including the Center of Epidemiological StudiesDepression Scale (CES-D). They were then assessed annually up to 11 years. Longitudinal changes of CES-D, modeled by a joint modeling approach of repeated measures and survival data, were used to predict mortality at follow-up (15 years after baseline), while adjusting for five classes of covariates.Results-Total mortality rate was 69.9%. CES-D at baseline was not predictive of mortality at 15-year follow-up after adjusting for baseline covariates. The joint modeling revealed that an annual increase of one point in CES-D scores over the years was associated with a 57% higher risk of mortality (HR = 1.57, p<.001) at follow-up. Compared to those whose CES-D scores were stable over time, subjects with increasing CED-D scores over time had a 70% increase in mortality risk, p<.001, and their median survival time was 4 years shorter.Conclusion-Although baseline CES-D was not predictive of mortality, the increase in depressive symptoms over time was associated with higher mortality. It is important to assess longitudinal changes in depression. KeywordsDepression; Mortality; Longitudinal Study; Joint Modeling; Elderly; Community Sample Depression is a common psychiatric condition that is prevalent in both younger and older populations (1). It is a disabling as well as deadly disorder. Depression may negatively affect health and mortality via multiple mechanisms (2-6), such as decreased heart rate variability, Corresponding author: Jian-Ping Zhang, MD, PhD, Department of Psychiatry and Psychology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk P57, Cleveland, OH 44195, jpzhang2005@gmail.com. NIH Public Access Author ManuscriptPsychosom Med. Author manuscript; available in PMC 2010 September 1. Published in final edited form as:Psychosom Med. 2009 September ; 71(7): 704-714. doi:10.1097/PSY.0b013e3181ac9bce. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript chronic activation of the Hypothalamus-Pituitary-Adrenal system, sedentary life style, reduced ability of self-care, and treatment non-compliance (7). These may be coupled with medical comorbidities such as coronary heart disease (CHD), which place them at a higher risk of mortality. Previous research has shown that depression is a risk factor for developing CHD (8,9), and is also associated with increased mortality among patients after their first episode of myocardial inf...