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Patients with cardiac disease, specifically ischemic heart disease and heart failure, have a higher frequency of major depressive disorder than patients without cardiac disease. The pathophysiologic reason for this is not completely understood. Previous depression, other debilitating illnesses, and type A personality are risk factors for the development of depression in cardiac patients. Depression has been shown to lower the threshold for ventricular arrhythmias. Therefore, treatment of depression potentially may prolong life in these patients. Antidepressant options that have been evaluated include several of the tricyclic antidepressants, trazodone, bupropion, and several of the selective serotonin reuptake inhibitors. Individual antidepressant drugs vary in their pharmacologic activity and side-effect profiles. Although clinical data are limited, it is important to individualize therapy in order to minimize cardiac adverse effects. Clinicians are encouraged to evaluate patients with cardiac disease for major depressive disorder and to consider antidepressant drug therapy for these patients when appropriate.
Depression is a common mood disorder that affects an unknown proportion of the population. The National Comorbidity Survey, an epidemiologic survey that examined the prevalence and risk-factor profiles of both pure and comorbid major depression, reported in 1994 that approximately 17% of Americans have had a major depressive disorder in their lifetime, and that approximately 10% have experienced an episode of depression within the past 12 months. Mood disorders are characterized by a disturbance in the regulation of mood, behavior, and affect. These disorders are subdivided into three categories: depressive disorder, bipolar disorder, and depression in association with a medical illness or alcohol or substance abuse. Major depressive disorder is characterized by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), as a condition in which five or more of the following symptoms are present for at least 2 weeks: depressed mood most of the day, markedly diminished interest or pleasure in all or almost all activities, changes in appetite (increased or decreased) with or without gain or loss of weight, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive guilt, diminished ability to think or concentrate (or indecisiveness), and suicidal ideation or thoughts of death.
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