Depression as a risk factor for cardiac mortality and morbidity: a review of potential mechanisms.
Depression increases the risk of cardiac mortality and morbidity in patients with coronary heart disease (CHD), but the mechanisms that underlie this association remain unclear. This review considers the evidence for several behavioral and physiological mechanisms that might explain how depression increases the risk for incident coronary disease and for subsequent cardiac morbidity and mortality. The candidate mechanisms include: (1). antidepressant cardiotoxicity; (2). association of depression with cardiac risk factors such as cigarette smoking, hypertension, diabetes, and reduced functional capacity; (3). association of depression with greater coronary disease severity; (4). nonadherence to cardiac prevention and treatment regimens; (5). lower heart rate variability (HRV) reflecting altered cardiac autonomic tone; (6). increased platelet aggregation; and (7). inflammatory processes. Despite recent advances in our understanding of these potential mechanisms, further research is needed to determine how depression increases risk for cardiac morbidity and mortality.
Carney
Robert M
RM
Department of Psychiatry, Suite 420, Behavioral Medicine Center, Washington University School of Medicine, 4625 Lindell Boulevard, St Louis, MO 63108, USA.
Freedland
Kenneth E
KE
Miller
Gregory E
GE
Jaffe
Allan S
AS
D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D002908:Chronic Disease; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology* / Q000401:mortality; D003866:Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology*; D006339:Heart Rate; D006801:Humans; D010349:Patient Compliance; D010974:Platelet Aggregation; D011379:Prognosis; D012307:Risk Factors
D000929:Antidepressive Agents, Tricyclic