Introduction

Anxiety and depressive disorders are common in the general population and are particularly prevalent in patients with cardiovascular disease (box 1).1^–3 ^w1-w3 We reviewed evidence for a biological explanation for this association and for drug treatment and psychotherapy for psychiatric morbidity in patients with cardiovascular disease.

Sources and selection criteria

We systematically searched Medline (1966 to August 2003 through Ovid) and Embase (1980 to October 2002) for all relevant English language articles. Firstly, we entered terms and text words including myocardial infarction, angina, hypertension, stroke, cerebrovascular, and poststroke. Secondly, we used the terms and text words “SSRIs”, “serotonin reuptake inhibitors”, and individual drug names. The searches were combined and relevant articles retrieved. The reference lists were searched for other potentially relevant articles.

Cardiovascular disease and psychiatric morbidity

Much evidence links depression with coronary artery disease and hypertension; 16% of patients assessed seven days after myocardial infarction had symptoms consistent with a major depressive episode.1 ^{w1 w2} Several studies have shown a link between anxiety disorders and coronary heart disease and between anxiety disorders and hypertension.2

Associations between psychiatric morbidity and cardiovascular disease could simply be attributed to patients being psychologically undermined after diagnosis but this does not explain prospective studies showing excess incidence of cardiovascular problems or poorer cardiovascular outcome in patients with depression and anxiety disorders. One study reported a 3.5-fold increase in mortality of depressed patients compared with non-depressed patients within six months of myocardial infarction.1 Depression has been associated with the development of cardiovascular complications in patients with hypertension, and several prospective studies have suggested a link between anxiety disorders and …