Depression as a risk factor for cardiac mortality and morbidity: A review of potential mechanisms

Robert M. Carney*, Kenneth E. Freedland, Gregory E. Miller, Allan S. Jaffe

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

609 Scopus citations


Depression increases the risk of cardiac mortality and morbidity in patients with coronary heart disease (CHD), but the mechanisms that underlie this association remain unclear. This review considers the evidence for several behavioral and physiological mechanisms that might explain how depression increases the risk for incident coronary disease and for subsequent cardiac morbidity and mortality. The candidate mechanisms include: (1) antidepressant cardiotoxicity; (2) association of depression with cardiac risk factor such as cigarette smoking, hypertension, diabetes, and reduced functional capacity; (3) association of depression with greater coronary disease severity; (4) nonadherence to cardiac prevention and treatment regimens; (5) lower heart rate variability (HRV) reflecting altered cardiac autonomic tone; (6) increased platelet aggregation; and (7) inflammatory processes. Despite recent advances in our understanding of these potential mechanisms, further research is needed to determine how depression increases risk for cardiac morbidity and mortality.

Original languageEnglish (US)
Pages (from-to)897-902
Number of pages6
JournalJournal of Psychosomatic Research
Issue number4
StatePublished - Oct 1 2002


  • Coronary heart disease
  • Depression
  • Mechanisms

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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