Beyond the Heart: The Significance of Depression in Cardiac Surgery

This narrative review examines the impact of depression on outcomes after cardiac surgery. The authors synthesized evidence from PubMed and Google Scholar, focusing on the epidemiology, mechanisms, and management of depression in this context. They report that preoperative depression is common, affecting up to 60 percent of patients, and is consistently linked to worse outcomes, including higher mortality, rehospitalizations, postoperative delirium, cognitive dysfunction, longer hospital stays, and reduced quality of life. Proposed mechanisms include inflammation, sympathetic overactivity, endothelial dysfunction, and platelet activation, compounded by adverse health behaviors and socioeconomic or psychosocial stressors. Women are diagnosed with depression more frequently, although male presentations may be underrecognized. The authors emphasize that depression is underdiagnosed in surgical practice, despite clear prognostic implications. They highlight evidence that the continuation of antidepressants, cognitive behavioral therapy, and structured exercise can improve outcomes. The review concludes that routine depression screening and the integration of psychological care into multidisciplinary perioperative pathways are essential.