Therapy vs medication: Treatments for depression in heart failure

Evan Walker
Evan Walker TheMediTary.Com |
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Experts say therapy is an effective treatment for people with heart disease who also have depression. VISUALSPECTRUM/Stocksy
  • About half of all people with heart failure in the United States also have depression.
  • Researchers report that behavioral activation therapy as well as antidepressants can help improve depressive symptoms.
  • Behavioral activation therapy is an evidence-based treatment for depression that focuses on the patient’s engagement in enjoyable activities.

Behavioral activation therapy is as effective as antidepressants for treating depression in people with heart failure, according to a new study published in the journal JAMA Network Open.

The researchers noted that in the United States, there are approximately 6 million adults with heart failure. About half of them experience symptoms of depression.

The researchers said people with both heart failure and depression have lower cardiac function, more emergency room visits, more hospital admissions, higher caregiver burden, and a lower quality of life compared to people with heart failure without depression.

The researchers, who were from the Department of Psychiatry and Behavioral Neuroscience at Cedars-Sinai Medical Center in Los Angeles, followed 416 people for one year to determine if there was a difference in outcome when either behavioral activation therapy or antidepressants were used to treat depression in people with heart failure.

Half of the study subjects received antidepressants and half participated in behavioral activation therapy. There were no statistical differences in demographic characteristics between the two groups.

Participants receiving behavioral activation therapy were assigned to meet with a social worker trained to provide this type of therapy.

Those receiving antidepressants were assigned to a registered nurse as a care manager to provide medications.

Both groups received a 50-minute introductory session with their assigned professional and then weekly sessions for 12 weeks.

During this initial 12-week period, the behavioral therapy group continued to have 50-minute sessions while the medication group had weekly 15-minute sessions. After the initial 12 weeks, both groups received monthly sessions for three months, followed by sessions on as as-needed basis for an additional 6 months.

Sessions were given via telehealth, reducing the burden of transportation and time on the patient and caregiver, which researchers said improved adherence and quality of life without compromising the effectiveness of the health care.

At the end of the year, the researchers reported there was no statistical difference in the effectiveness between the two groups. Both groups had more than a 50% reduction in the severity of their depressive symptoms.

“This study, which was conducted in a real-world setting, demonstrates that it is entirely feasible to incorporate psychiatric treatment into specialty medical care. Integrating psychiatric treatment into medical care is an effective way to reduce stigma, increase access, and improve outcomes for people who struggle with mental health problems alongside their chronic medical conditions,” said Dr. Itai Danovitch, a professor at Cedars-Sinai Medical Center and a co-author of the study, in a press release. “Most people who suffer from depression do not receive effective treatment. It is critical that we increase screening for psychiatric conditions and ensure that patients have access to high-quality and effective mental health care.”

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