Depression and Heart Failure: A Narrative Review of Their Complex Relationship and Clinical Implications

Depression is a prevalent and debilitating comorbidity that affects heart failure (HF) patients worldwide, with significant social and economic impacts. The multifaceted, bidirectional relationship between depression and HF involves shared pathophysiological mechanisms such as hypercoagulability, inflammation, and neurohormonal and autonomic dysregulation. Furthermore, behavioural factors such as smoking, physical inactivity, and medication non-adherence exacerbate the association between depression and HF. These complex pathways not only contribute to the development of heart failure in depressed people but also increase depressive symptoms in heart failure patients, creating a vicious cycle that affects overall well-being. Treatment of depression in heart failure patients requires an integrated approach, including non-pharmacological and pharmaceutical interventions. Despite the low efficacy of existing antidepressant medicines, there is a need for novel treatment techniques, and current research studies provide optimism for improving the overall prognosis and management of depression in this susceptible population. This review focuses on providing comprehensive care strategies that address both physical and mental health requirements as necessary, along with the importance of diagnosis and treatment of depression impacting heart failure to improve the overall prognosis and quality of life.