Psychological Depression and Cardiac Surgery: A Comprehensive Review

The psychological and neurological impact of cardiac surgery has been of keen empirical interest for more than two decades although reports showing the prognostic influence of depression
on adverse outcomes lag behind the evidence documented in heart
failure, myocardial infarction, and unstable angina. The paucity of
research to date is surprising considering that some pathophysiological
mechanisms through which depression
is hypothesized to affect coronary heart disease (e.g., platelet
activation, the inflammatory system, dysrhythmias) are known to be
substantially influenced by the use of cardiopulmonary bypass. As such, cardiac surgery
may provide a suitable exemplar to better understand the psychiatric
mechanisms of cardiopathogenesis. The extant literature is
comprehensively reviewed with respect to the deleterious impact of depression on cardiac and neuropsychological morbidity and mortality. Research to date indicates that depression and major depressive episodes increase major cardiovascular morbidity risk after cardiac surgery. The association between depressive disorders and incident delirium is of particular relevance to cardiac surgery staff. Contemporary treatment intervention studies are also described along with suggestions for future cardiac surgery research.