To evaluate the association of depression and antidepressant therapy with long-term mortality, O’Connor et al studied 1006 patients 18 years or older with clinical heart failure (HF) and an ejection fraction of 35% or lower. They found that 30% of patients in the study were depressed (Beck Depression Inventory score ≥10), and 24.2% of these patients were taking antidepressants. During a mean (SD) follow-up of 972 (731) days, 42.7% of the study participants died. Overall, the use of antidepressants was associated with increased mortality (unadjusted hazard ratio [HR], 1.32; 95% confidence interval [CI], 1.03-1.69). However, the association between antidepressants and increased mortality no longer existed after controlling for depression and other confounders (HR, 1.24; 95% CI, 0.94-1.64). Nonetheless, depression remained associated with increased mortality after adjustment for baseline confounders and antidepressant use (HR, 1.33; 95% CI, 1.07-1.66). Thus, this study suggests that depression, but not antidepressant use, is associated with increased mortality in patients with HF.