BACKGROUND: Although depression has been associated with cardiac death in coronary artery disease (CAD), little is known about the effects of depression on autonomic nervous system control of heart rate. This study evaluated whether depressive symptomatology is associated with impaired baroreflex sensitivity (BRS) in patients with CAD. METHODS AND RESULTS: BRS was assessed in 66 patients with stable CAD by using cross-spectral analysis to measure baroreceptor-mediated R-R interval oscillations. Depressive symptomatology was determined with the Beck Depression Inventory, with lower (scores <3, n = 14) and upper (scores >9, n = 16) quartiles of scores used to define groups with low and high depressive symptomatology, respectively. Comparison of the two groups showed that age-adjusted BRS was reduced in the patients with high depressive symptomatology when compared with patients with low depressive symptomatology (4.5 +/- 2.7 vs 6.5 +/- 2.8 ms/mm Hg; P <. 05). CONCLUSIONS: The current findings show that patients with CAD and depressive symptomatology have reduced BRS. Future studies are needed to examine whether reduced baroreflex cardiac control predicts cardiac risk in patients with CAD and depressive symptomatology.