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Psychological and pharmacological interventions for depression in patients with coronary artery disease
Harald Baumeister1, Nico Hutter, Jürgen Bengel
1Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, Freiburg, Germany, 79085.
Insights
Psychological and selective serotonin reuptake inhibitor (SSRI) interventions show small benefits for depression in coronary artery disease (CAD) patients. However, evidence for reducing mortality or cardiac events is limited, with sparse high-quality trials available.
Area of Science:
- Cardiology
- Psychiatry
- Clinical Trials
Background:
- Depression is prevalent in coronary artery disease (CAD) patients, negatively impacting prognosis.
- Comorbid depression in CAD requires effective management strategies.
Purpose of the Study:
- To evaluate the efficacy of psychological and pharmacological interventions for depression in adults with CAD.
- To assess impacts on mortality, cardiac events, and quality of life.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs).
- Searched multiple databases (e.g., MEDLINE, EMBASE, PsycINFO) with no language restrictions.
- Included RCTs assessing psychological or pharmacological treatments for depression in CAD patients.
Main Results:
- Psychological interventions demonstrated a small benefit for depression symptoms compared to usual care.
- Selective serotonin reuptake inhibitors (SSRIs) showed a small beneficial effect on depression outcomes versus placebo.
- Pharmacological interventions reduced hospitalization and emergency room visit rates.
- No significant benefits were observed for mortality, cardiac events, or overall quality of life.
Conclusions:
- Psychological and SSRI interventions may offer clinically meaningful improvements in depression for CAD patients.
- Current evidence does not support a reduction in mortality or cardiac events.
- The overall evidence base is limited by the scarcity of high-quality trials and population/intervention heterogeneity.
Background:
Depression occurs frequently in patients with coronary artery disease (CAD) and is associated with a poor prognosis.
Objectives:
To determine the effects of psychological and pharmacological interventions for depression in CAD patients with comorbid depression.
Search Strategy:
CENTRAL, DARE, HTA and EED on The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, ISRCTN Register and CardioSource Registry were searched. Reference lists of included randomised controlled trials (RCTs) were examined and primary authors contacted. No language restrictions were applied.
Selection Criteria:
RCTs investigating psychological and pharmacological interventions for depression in adults with CAD and comorbid depression were included. Primary outcomes were depression, mortality and cardiac events. Secondary outcomes were healthcare costs and health-related quality of life (QoL).
Data Collection And Analysis:
Two reviewers independently examined the identified papers for inclusion and extracted data from included studies. Random effects model meta-analyses were performed to compute overall estimates of treatment outcomes.
Main Results:
The database search identified 3,253 references. Sixteen trials fulfilled the inclusion criteria. Psychological interventions show a small beneficial effect on depression compared to usual care (range of SMD of depression scores across trials and time frames: -0.81;0.12). Based on one trial per outcome, no beneficial effects on mortality rates, cardiac events, cardiovascular hospitalizations and QoL were found, except for the psychosocial dimension of QoL. Furthermore, no differences on treatment outcomes were found between the varying psychological approaches. The review provides evidence of a small beneficial effect of pharmacological interventions with selective serotonin reuptake inhibitors (SSRIs) compared to placebo on depression outcomes (pooled SMD of short term depression change scores: -0.24 [-0.38,-0.09]; pooled OR of short term depression remission: 1.80 [1.18,2.74]). Based on one to three trials per outcome, no beneficial effects regarding mortality, cardiac events and QoL were found. Hospitalization rates (pooled OR of three trials: 0.58 [0.39,0.85] and emergency room visits (OR of one trial: 0.58 [0.34,1.00]) were reduced in trials of pharmacological interventions compared to placebo. No evidence of a superior effect of Paroxetine (SSRI) versus Nortriptyline (TCA) regarding depression outcomes was found in one trial.
Authors' Conclusions:
Psychological interventions and pharmacological interventions with SSRIs may have a small yet clinically meaningful effect on depression outcomes in CAD patients. No beneficial effects on the reduction of mortality rates and cardiac events were found. Overall, however, the evidence is sparse due to the low number of high quality trials per outcome and the heterogeneity of examined populations and interventions.
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