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Depression in the patient who has recently suffered a myocardial infarction is common, with an estimated prevalence of 20%. However, despite this high prevalence, depression in the post-myocardia infarction patient is poorly diagnosed and treated. In addition, depression in these patients has been associated with increased cardiac morbidity and mortality as well as increased disability and health care cost. The pathophysiology relating these two conditions remains unclear but may be related to autonomic dysfunction and enhanced risk of arrhythmias. Few well-designed trials have evaluated treatment options for these patients, although several large trials are underway. Of the antidepressant medications available, they all have potential interactions with the cardiac system. However, the serotonin selective reuptake inhibitors seem to be emerging as the best first line treatment option for these patients.