 Patients will be consented and screened within 2 to 6 months of the index ACS. Patients who have elevated depression BDI15 or BDI10 assessed twice over two week period and who continue to meet all of the trials eligibility criteria will be consented. Through informed consent, both arms of the trial will be described with equipoise as to these approaches to postACS depression care. Patients who consent to randomization will be enrolled in the treatment trial. 