title: Clinical predictors of depression treatment outcomes in patients with coronary heart disease.
abstract: Patients with coronary heart disease (CHD) who respond to treatment for depression are at lower risk of mortality than are nonresponders. This study sought to determine whether variables that have been shown to predict both depression treatment outcomes in psychiatric patients and cardiac events in patients with CHD, also predict poor response to depression treatment in patients with CHD.
  
  
  
  One hundred fifty-seven patients with stable CHD who met the DSM-IV criteria for a major depressive episode were treated with cognitive behavior therapy (CBT) for 16weeks, either alone or in combination with an antidepressant.
  
  
  
  The mean Beck Depression Inventory (BDI-II) score was 30.2±8.5 at baseline and 8.5±7.8 at 16weeks. Over 50% of the participants were in remission (HAM-D-17 score ≤7) at the end of treatment. Of the hypothesized predictors, severe depression at baseline (p=0.02), stressful life events during the first (p=0.03) and last (p<0.0001) 8weeks of treatment, and the completion of CBT homework assignments (p=0.001) predicted depression outcomes. History of prior episodes, anxiety symptoms, antidepressant therapy at study enrollment, and medical hospitalizations or emergency department visits during treatment did not predict treatment outcome.
  
  
  
  Patients who are under considerable stress do not respond as well to evidence-based treatments for depression as do patients with less stress. If future studies support these findings, more work will be needed to better address stressful life events in patients who may otherwise remain at high risk for mortality and medical morbidity following depression treatment.
authors: Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA. Electronic address: carneyr@bmc.wustl.edu.
authors: Robert M
authors: RM
authors: Carney
authors: Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
authors: Kenneth E
authors: KE
authors: Freedland
authors: Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
authors: Brian C
authors: BC
authors: Steinmeyer
authors: Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
authors: Eugene H
authors: EH
authors: Rubin
authors: Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
authors: Michael W
authors: MW
authors: Rich
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001007:Anxiety / Q000150:complications; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003327:Coronary Disease / Q000523:psychology*; D003865:Major Depressive Disorder / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D013315:Stress, Psychological; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents
keywords: Coronary heart disease; Major depression; Treatment