Why is depression bad for the failing heart? A review of the mechanistic relationship between depression and heart failure.
BACKGROUND
Depression is 4 to 5 times as common in heart failure (HF) patients as in the general population, might confer a higher risk of developing HF, and negatively affects prognosis in established HF.


RESULTS
A review was undertaken via Medline (1966-2003) and PsycINFO (1872-2003) searches using the subject headings "depressive disorder" and "heart failure, congestive." Our findings suggest that the link between depression and HF may be due to shared pathophysiology. Depression may augment catecholamine release, arrhythmias, elaboration of proinflammatory cytokines, and platelet activation--processes that may influence prognosis in HF. Depression is also associated with a higher risk of noncompliance and lower levels of social support, which have been shown to worsen prognosis in HF. The impact of pharmacologic or behavioral treatment for depression on physiologic parameters or clinical outcomes in HF remains unclear. Inherent difficulties in recognition of depression in the setting of HF may decrease the likelihood that depressed patients receive the treatment they need.


CONCLUSIONS
Depression is common in HF, may contribute to the development of HF in susceptible populations, and is independently predictive of poor clinical outcomes. Pathophysiologic pathways and psychosocial issues that are shared between the 2 conditions might explain these observations and represent potential therapeutic targets. Vigilant attention to the recognition and treatment of depression in HF patients is warranted.
Joynt
Karen E
KE
Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
Whellan
David J
DJ
O'connor
Christopher M
CM
D002395:Catecholamines / Q000378:metabolism; D016207:Cytokines / Q000378:metabolism; D003866:Depressive Disorder / Q000378:metabolism / Q000503:physiopathology* / Q000523:psychology; D006333:Heart Failure / Q000378:metabolism / Q000503:physiopathology* / Q000523:psychology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D010349:Patient Compliance; D012944:Social Support; D019851:Thrombophilia / Q000503:physiopathology
D002395:Catecholamines; D016207:Cytokines