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To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1532-5415.2010.02921.x Byline: Hendrika J. Luijendijk (*[dagger]), Henning Tiemeier (*[double dagger]), Julia F. van den Berg (*s.), Gysele S. Bleumink (*[parallel]), Albert Hofman (*), Bruno H.C. Stricker (*#) Keywords: depression; heart failure; loop-diuretics; cohort study Abstract: OBJECTIVES: To assess whether heart failure (HF) increases the risk of developing depression and whether the use of loop diuretics in persons with HF alters this risk. DESIGN: Population-based cohort study between 1993 and 2005. SETTING: Ommoord, a district of Rotterdam, the Netherlands. PARTICIPANTS: Five thousand ninety-five older adults free of depression at baseline. MEASUREMENTS: Detailed information on HF and depression was collected during examination rounds and through continuous monitoring of medical and pharmaceutical records. HF was defined according to the criteria of the European Society of Cardiology. Depressive episodes were categorized as clinically relevant depressive symptoms and depressive syndromes, including major depressive disorders defined according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. Hazard ratios (HRs) were calculated using multivariate Cox proportional hazard regression. RESULTS: HF was associated with greater risk of depressive symptoms and syndromes (HR=1.41, 95% CI=1.03-1.94) and depressive syndromes only (HR=1.66, 95% CI=1.09-2.52). In participants with HF, the use of loop diuretics was associated with a lower risk of depressive symptoms and syndromes (HR=0.46, 95% CI=0.22-0.96) and depressive syndromes only (HR=0.41, 95% CI=0.16-1.00). CONCLUSION: HF is an independent risk factor for incident depression in elderly persons. Patient with HF require careful follow-up to monitor and prevent the onset of depression. Effective treatment of the debilitating symptoms of HF may prevent depression. Author Affiliation: (*)Epidemiology ([parallel])Internal Medicine ([double dagger])Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands ([dagger])Department of Geriatric Psychiatry, BAVO Europoort, Rotterdam, the Netherlands (s.)Department of Geriatric Psychiatry, Parnassia, The Hague, the Netherlands (#)Inspectorate of Health Care, The Hague, the Netherlands. Article note: Address correspondence to Bruno H.Ch. Stricker, Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands. E-mail: b.stricker@erasmusmc.nl