Alzheimer's, Dementia & Mental Health
Patients with Depression After Heart Bypass Surgery
Find Relief from Non-Drug Treatments
Cognitive behavior therapy and supportive stress
management stopped most depressions from returning after nine months
April 6, 2009 It should not surprise anyone that
depressions are common about one out of five patients following
coronary artery bypass surgery. Two treatments not involving drugs,
however, have proven to be considerably better at helping these patents
than the usual care for treating depression.
The study of these two non-pharmacological
interventions - cognitive behavior therapy and supportive stress
management - appears in the April issue of Archives of General
Psychiatry, one of the JAMA/Archives journals.
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About 20 percent of patients experiences a major
depressive episode following coronary artery bypass graft (CABG) surgery
and at least that many develop milder forms of depression, 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) were free 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."
Editor's Note: This study was supported by
grants from the National Institute of Mental Health.
