Two nondrug treatments appear to reduce depression after heart surgery

Apr 06, 2009

cognitive behavior therapy and supportive stress management—appear more effective than usual care for treating depression after coronary artery bypass surgery, according to a report in the April issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

About one in every five patients experiences a major depressive episode following coronary artery bypass graft (CABG) surgery and at least that many develop milder forms of , according to background information in the article. "Depression around the time of surgery predicts postoperative complications, longer physical and emotional recovery, worse quality of life and increased rates of cardiac events and mortality [death]," the authors write, and may also be linked to problems with thinking, learning and memory.

Kenneth E. Freedland, Ph.D., of the Washington University School of Medicine, St. Louis, and colleagues conducted a randomized clinical trial involving 123 patients who had major or minor depression within one year after CABG surgery. Of these, 40 were randomly assigned to usual care as determined by primary care or other physicians and the other patients were assigned to one of two treatment groups.

This included 41 patients who underwent 12 weeks of cognitive behavior therapy, shown to be an effective treatment for depression in other populations. The individual, 50- to 60-minute sessions with a psychologist or social worker involved identifying problems and developing cognitive techniques for overcoming them, including challenging distressing automatic thoughts and changing dysfunctional attitudes. The other 42 patients received 12 weeks of supportive stress management, in which a social worker or psychologist counseled the patient about improving his or her ability to cope with stressful life events. Depressive symptoms were assessed at the beginning of the study and again after three, six and nine months.

After three months, more patients in the cognitive behavior therapy group (71 percent) and supportive stress management group (57 percent) experienced remission of their depression than in the usual care group (33 percent). The differences narrowed at the six-month follow-up but differed again at nine months (73 percent for the cognitive behavior therapy group, 57 percent for the supportive stress management group and 35 percent for the usual care group).

"Cognitive behavior therapy was also superior to usual care on most secondary psychological outcomes, including anxiety, hopelessness, perceived stress and the mental (but not the physical) component of health-related quality of life. On most of these measures, differences between cognitive behavior therapy and usual care were found at all three follow-up assessments," the authors write. "Supportive stress management was superior to usual care only on some of these measures."

"In conclusion, this randomized, controlled trial showed that cognitive behavior therapy was an efficacious treatment for depression in patients with a recent history of coronary bypass surgery," they continue. "Supportive stress management was also superior to usual care for depression in these patients, but it had smaller and less durable effects than cognitive behavior therapy."

More information: Arch Gen Psychiatry. 2009;66[4]:387-396

Source: JAMA and Archives Journals (news : web)

Explore further: Lift weights, improve your memory

add to favorites email to friend print save as pdf

Related Stories

Program helps improve management of chronic pain

Mar 24, 2009

Patients with chronic pain who took part in a collaborative care intervention that included patient and clinician education and symptom monitoring and feedback to the primary care physician had improvements in pain-related ...

Recommended for you

Lift weights, improve your memory

4 hours ago

Here's another reason why it's a good idea to hit the gym: it can improve memory. A new Georgia Institute of Technology study shows that an intense workout of as little as 20 minutes can enhance episodic ...

Fat chats: The good, the bad and the ugly comments

6 hours ago

Cyberbullying and hurtful 'fat jokes' are disturbingly prevalent in the social media environment, especially on Twitter, says Wen-ying Sylvia Chou of the National Institutes of Health in the US. Chou is lead ...

Omega-3 fatty acids may prevent some forms of depression

8 hours ago

Patients with increased inflammation, including those receiving cytokines for medical treatment, have a greatly increased risk of depression. For example, a 6-month treatment course of interferon-alpha therapy ...

User comments : 0