Sexual activity and cardiac risk: Is depression a contributing factor?

There is a well-documented association between depression, ischemic heart d isease, and cardiovascular mortality, This association has a number of dime nsions including: (1) depressed patients have a higher than expected rate o f sudden cardiovascular death; (2) over the course of ct lifetime, patients with depression develop symptomatic and fatal ischemic heart disease at a higher rate compared with a nondepressed group; and (3) depression after my ocardial infarction (MI) is associated with increased cardiac mortality. De pression is also associated with sexual dysfunction, particularly erectile dysfunction, If depression is the primary illness, then erectile dysfunctio n can be considered a symptom of the depressive illness. However, if the er ectile dysfunction is primary, men may develop a depressive syndrome in rea ction to the loss of sexual function. Regardless of whether erectile dysfun ction is a symptom of depression or depression is a consequence of erectile dysfunction, these conditions ore frequently comorbid, Thus, the patient w ith ischemic heart disease who is depressed is more likely to have erectile difficulties, An attempt by this patient to engage in sexual activity is t herefore more likely to be unsuccessful and, given the increase in cardiac mortality associated with depression, it may result in a serious cardiac ev ent. (C) 2000 by Excerpta Medica, Inc.