Vol 5 n° 2 - Psychiatric disorders in somatic medicine
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eart disease and depression are among the most common diseases seen in developed countries. The rela- tionship between heart disease and depression has been the  subject  of  both  popular  interest  and  scientific research. Sadness is often portrayed as a feeling of heav- iness in the chest or as a “broken heart.” Interestingly, as we  learn  more  about  the  expression  of  emotions,  it appears that these perceptions may simply be the lan- guage representation of the somatic feelings. In this arti- cle, I will review the scientific literature on the relation- ship between heart disease and depression. (For a more comprehensive   discussion,  the   interested   reader   is referred to an article by Jiang et al1).There are three ques- tions that I will address: first, whether depression is a risk factor for heart disease; second, whether depression can worsen  the  prognosis  of  heart  disease; and  third  and finally, the treatment of depression in the context of car- diac disease.The cardiac disease that is the most common and where the literature is the clearest is coronary artery disease (CAD). The focus of this article will thus be pri- marily on this condition. How common is depression among cardiac patients? Depression is not a surprising finding after an acute med- ical event such as a heart attack.What is a surprise is that the frequency is not higher. Cassem and Hackett2 found depressed mood to be common in 50% of patients imme- diately following a myocardial infarction (MI).What is of interest is that this is persistent, ie, more than 70% of patients remain depressed a year after the event. Not only was the depression present, but it also had functional con- sequences such as being related to inability to return to Keywords: depression; myocardial infarction; heart disease; sertraline; mortality Author  affiliations:  Professor  and  Chairman,  Department  of  Psychiatry  and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA Address for correspondence: K. Ranga R. Krishnan, Chairman, Department of Psychiatry, Duke University Medical Center, Durham, NC 27710, USA (e-mail: krish001@mc.duke.edu) C l i n i c a l   r e s e a r c h 1 6 7 Broken heart: depression in cardiovascular disease K. Ranga R. Krishnan, MD H Heart disease and depression are among the most com- mon diseases seen in developed countries. The relation- ship between heart disease and depression has been the subject of both popular interest and scientific research. Sadness is often portrayed as a feeling of heaviness in the chest or as a “broken heart.” Interestingly, as we learn more about the expression of emotions, it appears that these perceptions may simply be the language represen- tation of somatic feelings. Large, prospective, longitudi- nal studies that have examined the relationship between depression and development of coronary artery disease (CAD) have shown that depression is a risk factor for the development of CAD. Depression also increases mortality in patients with stable CAD or myocardial infarction com- pared  with  patients  without  depression.  The  recent Sertraline AntiDepressant HeARt attack Trial (SADHART) has shown that selective serotonin reuptake inhibitors like sertraline can be safely used in patients with depression following myocardial infarction. There is also intriguing evidence that treating depression with antidepressants may improve outcomes, including mortality. Dialogues Clin Neurosci. 2003;5:167-174.