There are exciting findings in the field of depression and coronary heart disease. Whether diagnosed or simply self-reported, depression continues to mark very high risk for a recurrent acute coronary syndrome or for death in patients with coronary heart disease. Many intriguing mechanisms have been posited to be implicated in the association between depression and heart disease, and randomized controlled trials of depression treatment are beginning to delineate the types of depression management strategies that may benefit the many coronary heart disease patients with depression. 1. Introduction Depression is quickly becoming the leading cause of years of life lived with disability worldwide [1] and has a particularly large impact on compromised health when comorbid with a chronic medical disorder [2]. More than 17 million American adults survived after an acute coronary syndrome (ACS), with 1.2 million new surviving cases added per year [3]. More than 2 out of every 5 of these patients have significant patient-reported depressive symptoms [4], and these symptoms will remain long after discharge [5]. Thus, as many as 7 million of Americans living with coronary heart disease (CHD) are also suffering with clinically significant depression, and we add half of a million new cases to this public health burden annually. As the comorbidity between these two conditions is high, and both predict increased occurrence of the other, a whole field has emerged to study the complex inter-relations of depression and ACS. For example, presence of a depressive disorder and/or minimally elevated depressive symptoms appears to be a robust risk and prognostic marker of CHD recurrence and all-cause mortality [4, 6, 7]. In this paper, the definition, measurement, epidemiology, mechanisms, screening, and treatment recommendations for depression comorbid with coronary heart disease will be presented, as will the controversies and future research directions in this interesting intersection between mental and physical disease. 2. Defining Depression Many researchers and much of the lay public assume that depression is a categorical disorder, and that those who suffer with symptoms typically associated with depression have a disease qualitatively different from everyday distress. Consequently, they consider that this cluster of symptoms should be viewed as one of a series of psychiatric illnesses, as described within the Diagnostic and Statistical Manual of Mental Disorders (DSM) [8]. However, there are others promoting continuous or dimensional views of these symptoms. Both
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