To the Editor of The New York Times:

‘‘Your Zoloft Might Prevent a Heart Attack,’‘ by Peter D. Kramer (Week in Review, June 23), and ”More Americans Seeking Help for Depression” (front page, June 18) address an emerging understanding of the two-way relationship between heart disease and depression. We know that depression occurs as a complication in 25 percent of heart attack victims; depression is also associated with a profoundly negative cardiac course, tripling or quadrupling the rate of heart attack recurrence and cardiac death.

While the annual cost of depression in the American workplace is estimated at $44 billion, if we further factor in costs associated with cardiac disease that has worsened as a function of depression, the true numbers are probably even more staggering.

Depression must be appropriately and aggressively treated. We simply cannot afford to maintain a distinction between mental and physical health and must champion health care and insurance reform that supports this understanding.

RONNIE S. STANGLER, M.D.

Published New York Times June 28, 2003