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

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 stress-management (57%) arms than in the usual care group (33%) (chi(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; chi(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.

Figures

Figure 1

Flowchart of participants through each stage of the trial. CBT indicates cognitive behavior therapy; SSM, supportive stress management; and UC, usual care.

Figure 2

Hamilton Rating Scale for Depression (HAM-D) scores at baseline, posttreatment (3 months), and at 6- and 9-month follow-ups. Both treatment arms were superior to usual care (UC) at 3 and 9 months in Tukey-adjusted planned contrasts. CBT indicates cognitive behavior therapy; SSM, supportive stress management.