title: Acute coronary syndrome and depression: A review of shared pathophysiological pathways.
abstract: OBJECTIVE
  To examine the evidence for shared pathophysiological pathways in acute coronary syndrome and major depression and to conceptualise the dynamic interplay of biological systems and signalling pathways that link acute coronary syndrome and depression within a framework of neuro-visceral integration.
  
  
  METHODS
  Relevant articles were sourced via a search of published literature from MEDLINE, EMBASE and PubMed using a variety of search terms relating to biological connections between acute coronary syndrome and depression. Additional articles from bibliographies of retrieved papers were assessed and included where relevant.
  
  
  RESULTS
  Despite considerable research efforts, a clear understanding of the biological processes connecting acute coronary syndrome and depression has not been achieved. Shared abnormalities are evident across the immune, platelet/endothelial and autonomic/stress-response systems. From the available evidence, it seems unlikely that a single explanatory model could account for the complex interactions of biological pathways driving the pathophysiology of these disorders and their comorbidity.
  
  
  CONCLUSIONS
  A broader conceptual framework of mind-body or neuro-visceral integration that can incorporate the existence of several causative scenarios may be more useful in directing future research and treatment approaches for acute coronary syndrome-associated depression.
authors.affiliation: School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Granville Smith
authors.affiliation: School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Gordon
authors.initials: G
authors.lastname: Parker
authors.affiliation: School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Poppy
authors.initials: P
authors.lastname: Rourke
authors.affiliation: School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Erin
authors.initials: E
authors.lastname: Cvejic
authors.affiliation: School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia ute@unsw.edu.au.
authors.forename: Uté
authors.initials: U
authors.lastname: Vollmer-Conna
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications* / Q000503:physiopathology*; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000453:epidemiology*; D006801:Humans; D019222:Mind-Body Relations, Metaphysical
keywords: Depression; acute coronary syndrome; autonomic nervous system; biological mechanisms; inflammatory response