Impacts of depression and emotional distress on cardiac disease.

Depression is a primary risk factor for ischemic heart disease (IHD) and a secondary risk factor for worsened prognosis in patients with IHD and heart failure. Mental stress-induced myocardial ischemia appears to be a significant mechanism by which depression increases the risk of death and morbidity in patients with IHD. A number of trials have evaluated the effect of therapy for depression in patients with cardiac disease, and more are ongoing. Selective serotonin reuptake inhibitors (SSRIs) are effective in improving depressive symptoms in cardiac patients and are relatively safe in these patients; tricyclic antidepressants are less safe in these patients. Early evidence suggests that antidepressant therapy with SSRIs may be associated with improved cardiac outcomes in depressed cardiac patients, but further study is needed.