Non-drug therapies reduce depression in bypass patients

School of Medicine researchers have found that non-drug therapies improve depression in heart patients following coronary bypass surgery. Both cognitive behavior therapy and supportive stress management are more effective at reducing depression symptoms than the type of care normally provided by cardiologists and primary-care physicians during recovery from bypass surgery.

For more than two decades, these researchers have been studying depression as a risk factor for heart attack and death in patients with heart disease. In this study, the first to look at treating depression in heart bypass patients, they learned that about one in five experience an episode of major depression following coronary artery bypass surgery and at least that many develop milder forms.

That’s bad news not only because patients feel bad but also because depression near the time of surgery is a known predictor of postoperative complications, longer recovery times, decreased quality of life and increased rates of future cardiac events and even death.

“Very little is known about how to treat depression in these patients and whether improving depression symptoms also may improve their medical prognosis,” said Kenneth E. Freedland, Ph.D., professor of psychiatry and first author of the study published in the April issue of the Archives of General Psychiatry.

“We weren’t concerned in this particular study with whether treatment would improve medical outcomes. We just wanted to see whether we could improve depression in these patients,” he said.

Because heart patients take a variety of drugs — and because both cognitive behavior therapy and supportive stress management help relieve depression in patients who don’t have heart disease — Freedland’s team tested non-drug therapies.

Freedland’s team followed 123 heart bypass surgery patients with depression. Of those, 40 were assigned to receive usual care as determined by their cardiologist or primary-care doctor; that is, their physicians made decisions about whether to prescribe antidepressants, and study investigators simply followed those patients to see how they did.

The other two study groups received treatment with non-drug therapies for depression that were provided by study investigators. One group of 42 subjects got 12 weeks of supportive stress management, in which a social worker or psychologist counseled them about improving their ability to cope with stressful life events.

The remaining 41 patients received 12 weeks of cognitive behavior therapy — weekly, hour-long sessions with a psychologist or social worker identifying problems and developing cognitive and behavioral techniques to overcome them. The researchers assessed symptoms of depression in all three groups at the beginning of the study and again after three, six and nine months.

At three months, 71 percent of patients who received cognitive behavior therapy and 57 percent in the supportive stress-management group had experienced remission of their depression, compared with only 33 percent of those in the usual-care group. By nine months, 73 percent of those who got cognitive behavior therapy, 57 percent of the supportive stress-management and 35 percent of the usual-care groups had experienced remission.

“The people in the cognitive-therapy group got much better and tended not to relapse,” Freedland said. “There also was improvement in the supportive stress management group, just not as much. But people with major depression who got usual care did not do well. Some sort of depression management is necessary.”

But that doesn’t necessarily mean antidepressant drugs. In this study, many of those enrolled were taking antidepressants. Whether a study subject was on antidepressant therapy was up to them and to their physician, but the drugs seemed to have little effect on whether they remained depressed.

“An antidepressant drug by itself didn’t seem to be enough,” Freedland said. “We found that about half of the patients already were getting an antidepressant, and yet they were still depressed. Whatever the drug might have been doing for them, it wasn’t doing enough.”

Freedland said it’s not possible yet to say whether either cognitive therapy or supportive stress management improves long-term cardiac outcomes in depressed, bypass surgery patients. But he said it is clear that both improve symptoms of depression.