Treatment of depression after coronary artery bypass surgery: a randomized controlled trial.
BACKGROUND
There has been little research on the treatment of depression after coronary artery bypass surgery.


OBJECTIVE
To test the efficacy of 2 nonpharmacological interventions for depression after coronary artery bypass surgery compared with usual care.


METHODS
A 12-week, randomized, single-blind clinical trial with outcome evaluations at 3, 6, and 9 months.


METHODS
Outpatient research clinic at Washington University School of Medicine, St Louis, Missouri.


METHODS
One hundred twenty-three patients who met the DSM-IV criteria for major or minor depression within 1 year after surgery.


METHODS
Twelve weeks of cognitive behavior therapy or supportive stress management. Approximately half of the participants were taking nonstudy antidepressant medications.


METHODS
Remission of depression, defined as a score of less than 7 on the 17-item Hamilton Rating Scale for Depression.


RESULTS
Remission of depression occurred by 3 months in a higher proportion of patients in the cognitive behavior therapy (71%) and supportive stress-management (57%) arms than in the usual care group (33%) (chi(2)(2) = 12.22, P = .002). Covariate-adjusted Hamilton scores were lower in the cognitive behavior therapy (mean [standard error], 5.5 [1.0]) and the supportive stress-management (7.8 [1.0]) arms than in the usual care arm (10.7 [1.0]) at 3 months. The differences narrowed at 6 months, but the remission rates differed again at 9 months (73%, 57%, and 35%, respectively; chi(2)(2) = 12.02, P = .003). Cognitive behavior therapy was superior to usual care at most points on secondary measures of depression, anxiety, hopelessness, stress, and quality of life. Supportive stress management was superior to usual care only on some of the measures.


CONCLUSIONS
Both cognitive behavior therapy and supportive stress management are efficacious for treating depression after coronary artery bypass surgery, relative to usual care. Cognitive behavior therapy had greater and more durable effects than supportive stress management on depression and several secondary psychological outcomes.


BACKGROUND
clinicaltrials.gov Identifier: NCT00042198.
Freedland
Kenneth E
KE
Department of Psychiatry, Washington University School of Medicine, 4320 Forest Park Ave, Ste 301, St Louis, MO 63108, USA. freedlak@bmc.wustl.edu
Skala
Judith A
JA
Carney
Robert M
RM
Rubin
Eugene H
EH
Lustman
Patrick J
PJ
Dávila-Román
Victor G
VG
Steinmeyer
Brian C
BC
Hogue
Charles W
CW
D000368:Aged; D015928:Cognitive Behavioral Therapy; D001026:Coronary Artery Bypass / Q000523:psychology*; D003376:Counseling; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000523:psychology* / Q000601:surgery; D010555:Personality Inventory / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D011594:Psychometrics; D016037:Single-Blind Method; D012944:Social Support