 There is considerable evidence that patients with ischemic heart disease IHD and concurrent major depression have a less favorable prognosis than patients with IHD alone. Indeed, a number of recent studies implicate major depression in the pathophysiologic progression of cardiovascular disease as an independent risk factor, rather than a reaction to cardiovascular illness. This conclusion is supported by multiple recent studies Anda et al; 1993; Markowitz and Matthews, 1991; Musselman et al., 1994, 1995. 