Depression is the most carefully studied mood disorder, having been reported in up to 33% of patients 1 year Depression is an important risk factor for the progression of CAD, and it is a more important predictor of CR success than many other variables.362 Both the presence of depressive symptoms before CABG and the worsening of these symptoms after surgery correlate with poorer physi- cal and psychosocial functioning and poorer quality of life Moreover, depression before or after surgery increases the risk of postoperative mortality and other adverse events such as heart failure hospitalization, MI, cardiac arrest, and the need for repeat revascularization.364,365 Finally, depres- sion after CABG is an important predictor for the recurrence of angina in the postoperative period.365 Interventions to help treat depression after CABG have been shown to be beneficial by improving depressive symptoms through cognitive behavioral therapy, telephone-delivered collaborative care, and supportive stress management.366,367 Participating in a CR program is another method that can help reduce postoperative depressive symptoms.368 In a random- ized, controlled trial, phone calls by nurses to patients after CABG improved depressive mood symptoms in the months Although interventions are frequently initiated postoperatively, cognitive behavioral therapy for preopera- tive depression and anxiety has also been shown to improve depressive symptoms and to reduce the length of stay in hospi- tal, justifying screening for depression even before the opera- Recently, a trial examining the efficacy of treating depression before surgery randomized 361 patients to escita- lopram 10 mg daily or placebo starting 2 to 3 weeks before elective CABG. Although the therapy had no effect on mor- bidity and mortality after CABG, depressed patients treated with escitalopram had a better quality of life and less pain Therefore, treating depression before CABG can lead to improved psychological outcomes after surgery. 