Over 51,000 individuals are diagnosed with a primary brain tumor in the United States each year, and for those with the most common type of malignant tumor, an astrocytoma, almost 75% will die within five years of diagnosis. While surgery, radiation, and chemotherapy have improved length of survival, mortality remains high, which underscores the need to understand how other factors affect the disease trajectory. Several recent studies have shown that depressive symptoms are independently associated with reduced quality of life and survival time after controlling for medial variables in patients with an astrocytoma. Thus, depressive symptoms represent a significant risk factor for adverse outcomes in this patient population.A growing body of evidence indicates that depressive symptoms are linked to underlying biological phenomena, particularly inflammatory activation modulated through increased peripheral levels of proinflammatory cytokines. Recent research has shown that neoplastic astrocytes respond to elevated proinflammatory cytokine levels by secreting immune mediators within the central nervous system, including cytokines and glial fibrillary acidic protein (GFAP) that promote astrogliosis and angiogenesis, and may increase tumor growth and metastasis. However, because these biological factors have not as yet been measured in conjunction with depressive symptoms in these patients, little is known about the interactions that potentially influence the treatment trajectory.In order to guide future research and provide a deeper understanding of the factors that may influence depressive symptoms and length of survival in patients with an astrocytoma, a review of the literature was undertaken. Publications over the past ten years were analyzed to examine the theoretical models and measures of depressive symptoms used in previous research. While numerous studies have documented the relationship between depression and reduced length of survival, there were several methodological concerns identified and there were no studies which included biological variables. Yet, research in the basic sciences provides compelling evidence of specific neuroendocrine-immune interactions orchestrated by astrocytes that can cause depressive NIH Public Access Astrocytomas are a complex group of low-and high-grade tumors that comprise more than half of all primary brain tumors (Bondy et al., 2008). They are the most frequent cerebral tumor, with an incidence estimated at 1/12,500. Most patients diagnosed with an astrocytoma, regardless of the tumor grade, will not live beyond five years (Lin et al., 2002). Affecting primarily middle-age adults, astrocytomas disrupt the lives of thousands of individuals and families each year as neurocognitive and functional status often deteriorate rapidly over the ensuing months. Besides the grade of astrocytoma, patient age and functional status remain the known preoperative prognostic indicators of survival (McCarter et al., 2006;Lutterbach, Sauerbrei, & Guttenberg, 2003). However, several r...