title: A dynamic view of comorbid depression and generalized anxiety disorder symptom change in chronic heart failure: the discrete effects of cognitive behavioral therapy, exercise, and psychotropic medication.
abstract: OBJECTIVE
  No previous study has reported upon comorbid depression and anxiety disorders and their treatment in heart failure (HF), which the current study has sought to document.
  
  
  METHODS
  Total 29 HF patients under psychiatric management underwent primary depression cognitive behavioral therapy (CBT; n = 15) or primary generalized anxiety disorder (GAD) CBT (n = 14), and participated in a community exercise program and standard physician care. Repeated measures analysis of variance assessed Patient Health Questionnaire (PHQ-9) and GAD-7 symptom change pre- and post-CBT treatment, and assessed the interaction effects of treatment type, exercise, anti-depressant and anxiolytic.
  
  
  RESULTS
  There was a significant time and treatment interaction effect that favored the primary GAD CBT group for reduction in PHQ symptoms (F(1, 24) = 4.52, p = 0.04). Analysis of PHQ-somatic symptoms also showed a significant main effect for participation in the exercise program (F(1, 24) = 4.21, p = 0.05) and a significant time and anxiolytic interaction (F(1, 24) = 3.98, p = 0.05). The average number of cardiac hospital readmissions favored the primary GAD CBT group (p = 0.05).
  
  
  CONCLUSIONS
  The findings support the use of multifaceted interventions in the rehabilitation of HF patients with comorbid psychiatric needs. Implications for Rehabilitation Comorbid depression and anxiety disorders are a clinical and research focus that deserves more attention in the treatment of heart failure patients. Cognitive behavioral therapy, exercise, and anxiolytic use was associated with significant changes in depression and anxiety though discrete effects were evident. Multifaceted interventions are most likely to be successful in the rehabilitation of HF patients with psychiatric needs.
authors: Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide , Adelaide , Australia .
authors: Phillip J
authors: PJ
authors: Tully
authors: Terina
authors: T
authors: Selkow
authors: Jürgen
authors: J
authors: Bengel
authors: Chiara
authors: C
authors: Rafanelli
mesh_terms: D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000453:epidemiology / Q000628:therapy*; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology / Q000628:therapy*; D004358:Drug Therapy; D005081:Exercise Therapy; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D013021:South Australia; D011795:Surveys and Questionnaires
keywords: Anti-depressant; anxiolytic; cognitive behavioral therapy; exercise major depression disorder; generalized anxiety disorder; heart failure