title: Benefits of collaborative care for post-CABG depression are not related to adjustments in antidepressant pharmacotherapy.
abstract: OBJECTIVE
  To determine whether the use and adjustment of antidepressant pharmacotherapy accounted for the beneficial effects of collaborative care treatment on the improvement of mood symptoms and health-related quality of life (HRQoL) after coronary artery bypass graft (CABG) surgery.
  
  
  METHODS
  In a post-hoc analysis of data from the Bypassing the Blues (BtB) trial we tested the impact of antidepressant medication on changes in depression and HRQoL from the early postoperative period to 8-month follow-up. Two hundred fifty-nine depressed post-CABG patients scoring ≥10 on the Patient Health Questionnaire-9 were classified in four groups according to whether or not they received antidepressants at baseline and 8-months following randomization.
  
  
  RESULTS
  Patients using antidepressant pharmacotherapy at baseline and follow-up tended to be younger and female (p≤0.01), but were similar in various clinical characteristics. Just 24% (63/259) of patients were on an antidepressant at baseline which increased to 36% at follow-up (94/259). Compared to other groups, patients on antidepressants at both baseline and follow-up assessment showed the smallest improvement in mood symptoms and HRQoL. While multivariate analyses confirmed that randomization to collaborative care was associated with greater improvement in mood symptoms (odds ratio [OR]=3.1; 95%-confidence interval [CI]=1.8-5.4, p<0.0001) and mental HRQoL (OR=3.6, CI=1.4-9.3, p=0.01), use of antidepressant medication had no differential impact on either measure (p=0.06 and p=0.92, respectively).
  
  
  CONCLUSIONS
  The beneficial effects of collaborative care for post-CABG depression were not generated by adjustments in antidepressant medication.
  
  
  BACKGROUND
  Clinicaltrials.gov Identifier: NCT00091962. (http://clinicaltrials.gov/ct2/show/NCT00091962?term=rollman+cabg&rank=1).
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen, Göttingen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Meyer
authors.affiliation: Disivion of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Bea Herbeck
authors.initials: BH
authors.lastname: Belnap
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen, Göttingen, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Herrmann-Lingen
authors.affiliation: Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Fanyin
authors.initials: F
authors.lastname: He
authors.affiliation: Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Sati
authors.initials: S
authors.lastname: Mazumdar
authors.affiliation: Disivion of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Rollman
mesh_terms: D000223:Adaptation, Psychological; D000339:Affect; D000368:Aged; D000928:Antidepressive Agents / Q000008:administration & dosage*; D001638:Bibliotherapy; D003299:Cooperative Behavior; D001026:Coronary Artery Bypass / Q000523:psychology*; D003863:Depression / Q000188:drug therapy / Q000628:therapy*; D004334:Drug Administration Schedule; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D011788:Quality of Life; D012017:Referral and Consultation; D057832:Watchful Waiting
chemical_list: D000928:Antidepressive Agents
keywords: Antidepressant pharmacotherapy; Collaborative care; Coronary artery bypass surgery; Depression; Health-related quality of life