The BI-directional Relationship Between Cardiac Arrhythmia and Depression: Neurocardiac Mechanisms, Risk Factors, and Emerging Therapeutic Strategies

Purpose of review Cardiac rhythm disorders and depressive disorders are often comorbid, contributing to a complex clinical picture stemming from shared biological pathways and lifestyle-related risks. This narrative review summarizes the current body of evidence to highlight the links between these two conditions and the implications for clinical populations. Recent findings Using purposefully interdisciplinary modalities, we searched key biomedical databases for publications focused on epidemiological links, neurocardiac pathways, risk factor modification, and combined interventions. The data suggest that an imbalance of the autonomic nervous system, chronic inflammation, neuroendocrine dysregulation, and structural cardiac adaptations connect the pathways through which depression increases risk for cardiac rhythm disturbance, and in turn rhythm disturbances increase psychological distress. Further, modifiable risks (e.g., obesity, hypertension, sleep-disordered breathing, diabetes, tobacco use) contribute substantially to both conditions, and health-based and behavioral interventions can improve outcomes in these conditions. Further, pharmacotherapy requires careful and thoughtful selection as there are overlapping physiological systems of action for some antidepressants and antiarrhythmics. Summary The review highlights the importance of multi-domain treatment actions that involve cardiovascular care and mental health. Future mechanistic research, precise risk prediction, and interventional studies will be critical to improving patients’ survival and daily functioning following a cardiac arrhythmia and the experience of depression.