Expanding the knowledge on the long-term bidirectional relationship between depressive symptoms and coronary heart disease (CHD) is key for decreasing the excess morbidity and mortality associated with both conditions, and for reducing healthcare costs. Patients with CHD exhibit a higher incidence of depression or subclinical depression.1 In addition, depressive symptoms have been associated with up to a 4.5-fold increase in the incidence of CHD, even in the presence of other relevant risk factors.1 The prospective association between these two conditions is strong and consistent across different age strata, gender and racial groups.2 In addition, many studies have provided evidence for a synergistic effect of CHD and depression on mortality, as well as on a poorer prognosis with regard to clinical outcomes, treatment adherence and functional indicators. For instance, depressed postmyocardial infarct patients are more likely to withdraw from exercise programmes, and depressed patients with CHD are less likely to adhere to low-dose aspirin therapy.1 Based on the available evidence, UK general practitioners have received extra remuneration for identifying depression in patients with CHD since 2006,3 and a pilot trial of a nurse-led personalised care, which combines case management and self-management theory, have suggested promising results for the treatment of patients with both CHD and depression.4

The Whitehall study II (https://www.ucl.ac.uk/whitehallII) has provided an important contribution to uncover the bidirectional relationship between psychological suffering and cardiovascular diseases in a broad-spectrum population. In their Heart manuscript, they expand prior evidence by linking CHD to long-term trajectories of psychological distress.5 Mood disorders are generally episodic, exhibiting fluctuations throughout their course; thus, the severity of symptoms at one-time point may not be the best way to apprehend the longitudinal burden of such disorders.6 In a …