The incidence of depression in patients with heart failure ranges from 21% to 42%. Depression is a growing independent risk factor for high mortality, re-hospitalization and deterioration of the quality of life. The advanced stage of heart failure along with the low ejection fraction and functional class has a direct correlation with the extent of depression. Medical professionals may measure depression by using the GESS I CAMP acronym (Guilt, Energy, Sleep, Suicide Interest, Concentration, Appetite, Mood, Psychomotor) as a helpful method of evaluation, or either of a variety of readily administered and graded self-report questionnaires. Cognitive behavioral counseling explores the associations with the environment, physiology, attitudes, emotions, and how these may be changed to yield changes in behavior and mood. The STEPS acronym can be helpful: Safety, Tolerability, Efficacy, Payment, and Simplicity). Pharmaceutically, selective serotonin re-uptake inhibitors are endorsed, although tricyclic antidepressants are not prescribed in patients with heart failure. The use of a potent serotonin re-uptake inhibitor and cognitive behavioral treatment is also helpful when used together.