Purpose of review <p>This review describes the complex relationships between depression, anxiety, and bipolar disorder with atherosclerosis by discussing epidemiological evidence, implicated mechanisms, and the impact of psychiatric interventions on cardiovascular outcomes.</p> Recent findings <p>Depression, anxiety, and bipolar disorder convey independent risk for atherosclerosis. Further, the presence of cardiovascular disease often contributes to worsened psychiatric symptoms. Current evidence supports a rising prevalence of psychiatric disorders in association with atherosclerosis and demographic disparities, with stronger links in women and African Americans. Shared biological mechanisms include autonomic dysfunction, hypothalamic-pituitary-adrenal axis overactivity, inflammation, and vascular effects. Pharmacological treatments and behavioral therapies, such as psychotherapy, have the potential to reduce cardiovascular events and improve physiological markers.</p> Summary <p>The expanding understanding of the bidirectional link between depression, anxiety, and bipolar disorder and atherosclerosis calls for integrated care. Early screening and management of these psychiatric disorders may help to slow cardiovascular disease progression.</p> Graphical Abstract <p></p>