Depression Treatment for Patients with Acute Coronary Syndromes

Peter Roy-Byrne, MD

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In This Article

Abstract and Introduction

Abstract

Consistent with other studies, depression improved with this collaborative intervention; cardiac outcomes improved too, but this novel finding was based on a relatively small number of patients and events.

Introduction

In cardiac patients with depression, cardiac outcomes (i.e., recurrent cardiac events and mortality) are worse than in nondepressed cardiac patients; several large studies have shown that treating depression reduces depressive symptoms and improves quality of life, but rarely improves cardiac outcomes. In a randomized, controlled, 6-month trial, 157 patients with acute coronary syndromes (ACSs) and persistent (>3 months) depressive symptoms received a depression intervention or usual care. The collaborative, "stepped-care" intervention differed from previous interventions in allowing patients to choose problem-solving therapy, antidepressants, or both, as well as to switch, add, or adjust treatment, depending on response, at 8-week intervals. The researchers also followed a cohort of 80 nondepressed ACS patients.

At 6 months, intervention patients were significantly more likely than usual-care patients to receive antidepressant medication (48% vs. 30%) or psychotherapy (39% vs. 12%) and had greater improvements in depression (moderate-to-large effect size of 0.59) and more satisfaction with depression care (54% vs. 19%). Intervention patients also had significantly fewer major adverse cardiac events (4% vs. 13%), with an event rate similar to that seen in nondepressed controls (6%).

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