Depression and the Link with Cardiovascular Disease

Abstract

This review provides an outline of the association between major depressive disorder (MDD) and coronary heart disease (CHD). Much is known about the two individual clinical conditions; however, it is not until recently, biological mechanisms have been uncovered that link both MDD and CHD. The activation of stress pathways have been implicated as a neurochemical mechanism that links MDD and CHD. Depression is known to be associated with poorer outcomes of CHD. Psychological factors, such as major depression and stress, are now known as risk factors for developing CHD, which is as important and is independent of classic risk factors, such as hypertension, diabetes mellitus, and cigarette smoking. Both conditions have great socioeconomic importance given that depression and CHD are likely to be two of the three leading causes of global burden of disease. Better understanding of the common causal pathways will help us delineate more appropriate treatments.

Keywords: cardiac risk; cardiovascular disease; coronary heart disease; depression; major depressive disorder.

Figure 1

Possible mechanisms whereby depression confers elevated cardiac risk. This is likely to be multifactorial including sympathetic activation, hypothalamic–pituitary activation, endothelial dysfunction, platelet activation, proinflammatory cytokines, and atherosclerosis development along with cardiac vascular and rhythm abnormalities.