Editorial: Depression in Heart Failure is Double Trouble: Warding off the Blues Requires Early Screening Ragavendra R. Baliga, MD, MBA Heart Failure.

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Editorial: Depression in Heart Failure is Double Trouble: Warding off the Blues Requires Early Screening Ragavendra R. Baliga, MD, MBA Heart Failure Clinics Volume 7, Issue 1, Pages xiii-xvii (January 2011) DOI: 10.1016/j.hfc.2010.10.004 Copyright © 2011 Elsevier Inc. Terms and Conditions

Fig. 1 Potential mechanisms linking depression and anxiety with adverse cardiac outcomes. CHD, coronary heart disease. (From Konstam V, Moser DK, De Jong MJ. Depression and anxiety in heart failure. J Card Fail 2005;11(6):455–63; with permission.) Heart Failure Clinics 2011 7, xiii-xviiDOI: (10.1016/j.hfc.2010.10.004) Copyright © 2011 Elsevier Inc. Terms and Conditions

Fig. 2 Hypothetical pathophysiologic alternations associated with depression that likely contribute to increased vulnerability to cardiovascular disease. Autonomic nervous system innervation of the heart via parasympathetic vagus (X) and sympathetic (postganglionic efferents from cervical and upper thoracic paravertebral ganglia) nerves are shown. ACTH, corticotropin; CRF, corticotrophin-releasing factor; HPA, hypothalamic-pituitary-adrenocortical axis; HRV, heart rate variability; HPA, hypothalamic-pituitary-adrenocortical axis; IL-1, interleukin-1; IL-6, interleukin-6; TNF-α, tumor necrosis factor α. (From Musselman DL, Evans DL, Nemeroff CB. The relationship of depression to cardiovascular disease: epidemiology, biology, and treatment. Arch Gen Psychiatry 1998;55:580–92; with permission.) Heart Failure Clinics 2011 7, xiii-xviiDOI: (10.1016/j.hfc.2010.10.004) Copyright © 2011 Elsevier Inc. Terms and Conditions

Fig. 3 The Patient Health Questionnaire. Total Score: 1–4 Minimal depression; 5–9 Mild depression; 10–14 Moderate depression; 15–19 Moderately severe depression; 20 -27 Severe depression. (From MacArthur Foundation Initiative on Depression and Primary Care. PRIME-MD Patient Health Questionnaire. Copyright © 1999, Pfizer Inc; MacArthur Toolkit. Copyright April 2006, 3CM, LLC; with permission. Also Available at: http://www.depression-primarycare.org/.) Heart Failure Clinics 2011 7, xiii-xviiDOI: (10.1016/j.hfc.2010.10.004) Copyright © 2011 Elsevier Inc. Terms and Conditions

Ragavendra R. Baliga, MD, MBA, Consulting Editor Heart Failure Clinics 2011 7, xiii-xviiDOI: (10.1016/j.hfc.2010.10.004) Copyright © 2011 Elsevier Inc. Terms and Conditions

James B. Young, MD, Consulting Editor Heart Failure Clinics 2011 7, xiii-xviiDOI: (10.1016/j.hfc.2010.10.004) Copyright © 2011 Elsevier Inc. Terms and Conditions