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Abstract
Although research has consistently established that depression and elevated depressive symptoms are associated with an increased risk of coronary heart disease (CHD) recurrence and mortality, clinical trials have failed to show that conventional depression interventions offset this risk. As depression is a complex and heterogeneous syndrome, we believe that examining simpler, or intermediary, phenotypes rather than one complex phenotype may allow better identification of those at particular risk of CHD recurrence and mortality. This approach may further contribute to the development of specific depression treatments that would improve medical outcomes. Although there are many possible intermediary phenotypes (IPs), specifiers and dimensions of depression, we will focus on only two when considering the relation between depression and risk of CHD recurrence and mortality: Incident Depression and Anhedonic Depression. Future research on IPs of depression is needed to clarify which are associated with the greatest risk for CHD recurrence and mortality and which, if any, are benign. Theoretical advances in depression phenotyping may also help elucidate the behavioural and biological mechanisms underlying the increased risk of CHD among patients with specific depression phenotypes. Finally, tests of depression interventions may be guided by this new theoretical approach.