Relationship Between Major Depression and Cardiovascular Disease

Hypothetical schema of pathophysiologic findings associated with depression that probably contributes to increased susceptibility to cardiovascular disease. Autonomic nervous system innervation of the heart via the parasympathetic vagus (X) nerve and sympathetic (postganglionic efferents from the cervical and upper thoracic paravertebral ganglia) nerves is shown. ACTH = corticotropin; CRF = corticotropin-releasing factor; HRV = heart rate variability; HPA = hypothalamic-pituitary-adrenocortical axis; IL-1 = interleukin-1; IL-6 = interleukin-6; TNF-α= tumor necrosis factor-α. (From Arch Gen Psychiatry, July 1998;55: p 583. Copyright (1998), American Medical Association.)