Treatment of depression after coronary artery bypass surgery a randomized controlled trial

Kenneth E. Freedland, Judith A. Skala, Robert M. Carney, Eugene H. Rubin, Patrick J. Lustman, Victor G. Dávila-Román, Brian C. Steinmeyer, Charles W. Hogue

Research output: Contribution to journalArticle

Abstract

Context: 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. Design: A 12-week, randomized, single-blind clinical trial with outcome evaluations at 3, 6, and 9 months. Setting: Outpatient research clinic at Washington University School of Medicine, St Louis, Missouri. Patients: One hundred twenty-three patients who met the DSM-IV criteria for major or minor depression within 1 year after surgery. Intervention: Twelve weeks of cognitive behavior therapy or supportive stress management. Approximately half of the participants were taking nonstudy antidepressant medications. Main Outcome Measure: 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 stressmanagement (57%) arms than in the usual care group (33%) (χ 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; χ 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. Trial Registration: clinicaltrials.gov Identifier: NCT00042198

Original languageEnglish (US)
Pages (from-to)387-396
Number of pages10
JournalArchives of General Psychiatry
Volume66
Issue number4
DOIs
StatePublished - Apr 2009

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Coronary Artery Bypass
Randomized Controlled Trials
Cognitive Therapy
Depression
Therapeutics
compound A 12
Ambulatory Care Facilities
Research
Diagnostic and Statistical Manual of Mental Disorders
Antidepressive Agents
Anxiety
Quality of Life
Medicine
Outcome Assessment (Health Care)
Clinical Trials
Psychology

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Freedland, K. E., Skala, J. A., Carney, R. M., Rubin, E. H., Lustman, P. J., Dávila-Román, V. G., ... Hogue, C. W. (2009). Treatment of depression after coronary artery bypass surgery a randomized controlled trial. Archives of General Psychiatry, 66(4), 387-396. https://doi.org/10.1001/archgenpsychiatry.2009.7

Treatment of depression after coronary artery bypass surgery a randomized controlled trial. / Freedland, Kenneth E.; Skala, Judith A.; Carney, Robert M.; Rubin, Eugene H.; Lustman, Patrick J.; Dávila-Román, Victor G.; Steinmeyer, Brian C.; Hogue, Charles W.

In: Archives of General Psychiatry, Vol. 66, No. 4, 04.2009, p. 387-396.

Research output: Contribution to journalArticle

Freedland, KE, Skala, JA, Carney, RM, Rubin, EH, Lustman, PJ, Dávila-Román, VG, Steinmeyer, BC & Hogue, CW 2009, 'Treatment of depression after coronary artery bypass surgery a randomized controlled trial', Archives of General Psychiatry, vol. 66, no. 4, pp. 387-396. https://doi.org/10.1001/archgenpsychiatry.2009.7
Freedland, Kenneth E. ; Skala, Judith A. ; Carney, Robert M. ; Rubin, Eugene H. ; Lustman, Patrick J. ; Dávila-Román, Victor G. ; Steinmeyer, Brian C. ; Hogue, Charles W. / Treatment of depression after coronary artery bypass surgery a randomized controlled trial. In: Archives of General Psychiatry. 2009 ; Vol. 66, No. 4. pp. 387-396.
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