Depression and coronary artery disease: review of the literature

A Comprehensive review of the literature regarding depression and coronary artery disease based on PubMed database was performed. Depression and coronary artery disease (CAD) are common health problems, which are often co-morbid. The World Health Organization (WHO) has estimated that by the year 2020 depression and CAD will be the first two leading causes of disability in the general population. This co-morbidity has been known for decades, but the modern understanding of the relationship can be traced to the mid-19th Century. Research in the 20th Century found that the relationship between depression and CAD is bi-directional. Several psychosocial risk factors contribute to the development of cardiovascular disease and influence the course of those who have it. Risk factors include anger, hostility, social isolation, stress, anxiety and depression. Similar strong associations were thought to exist between cardiovascular disease and personality traits known as type A or type D personalities. The explanation of the relationship between depression and CAD is multifactorial. It involves noradrenergic and hypothalamic pituitary adrenal cortical system, autonomic nervous system, platelet activation and inflammatory process. The first line of treatment for depression in patients with CAD is the SSRI class of antidepressants. Treating depression in CAD patients improves outcomes. It is of great importance that physicians who treat cardiac patients should be able to diagnose and treat depression in their patients, which may result in better prognosis.