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Depression is a risk factor for medical morbidity and mortality in patients with coronary heart disease (CHD). Dysregulation of theautonomic nervous system (ANS) may explain why depressed patients are at increased risk. Studies of medically well, depressedpsychiatric patients have found elevated levels of plasma catecholamines and other markers of altered ANS function compared withcontrols. Studies of depressed patients with CHD have also uncovered evidence of ANS dysfunction, including elevated heart rate,low heart rate variability, exaggerated heart rate responses to physical stressors, high variability in ventricular repolarization, andlow baroreceptor sensitivity. All of these indicators of ANS dysfunction have been associated with increased risks of mortality andcardiac morbidity in patients with CHD. Further research is needed to determine whether ANS dysfunction mediates the effects ofdepression on the course and outcome of CHD, and to develop clinical interventions that improve cardiovascular autonomicregulation while relieving depression in patients with CHD. Key words: autonomic nervous system, coronary disease, depression,depressive disorder, mortality, myocardial infarction.