Previous evidence suggests there is an association between cardiovascular disease and depression. Tricyclic antidepressants (TCAs) are contraindicated in patients with a recent history of cardiovascular disease. 5678 patients between the ages of 50 and 79 years and with a new acute cardiac event were selected from a computerised general practice database and followed up for one year. `New episodes' of diagnosed depression were identi®ed and treatment with antidepressants was investigated. 183 656 patients aged 50±79 years without a cardiac event were used for comparison. A signi®cant association was found between cardiovascular disease and a new diagnosis of depression (adjusted OR 2 . 23, 95 per cent CI 1 . 90±2 . 62). Patients who had suered a recent cardiac event were less likely to be prescribed a TCA than an SSRI (adjusted OR 0 . 59, 95 per cent CI 0 . 41±0 . 85). However, 35 per cent of patients with a recent cardiac event were initially prescribed a TCA. The ®ndings indicate that general practitioners recognise the dangers of prescribing TCAs to patients with a recent history of cardiovascular disease. However, a substantial minority of cardiac patients were prescribed TCAs where they may not have been the optimal choice.