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Residual Symptoms After Treatment for Depression in Patients With Coronary Heart Disease
Robert M Carney1, Kenneth E Freedland, Brian C Steinmeyer
1From the Departments of Psychiatry (Carney, Freedland, Steinmeyer, Rubin) and Medicine (Rich), Washington University School of Medicine, St. Louis, Missouri.
Insights
Even after successful depression treatment, coronary heart disease patients often experience persistent fatigue and loss of energy. These symptoms may increase risks for relapse and mortality, highlighting a need for new interventions.
Area of Science:
- Cardiology
- Psychiatry
- Clinical Psychology
Background:
- Depression significantly increases mortality risk in patients with coronary heart disease (CHD).
- While treatment can reduce this risk, complete remission from depression is rare in this population.
- Identifying persistent depressive symptoms is crucial for managing CHD patients.
Purpose of the Study:
- To identify symptoms that remain despite aggressive treatment for depression in patients with CHD.
- To understand the characteristics of residual depression symptoms in CHD patients.
Main Methods:
- 125 patients with stable CHD and moderate-to-severe depression were treated with cognitive behavior therapy (alone or with antidepressants) for 16 weeks.
- Depression symptoms were assessed using the Beck Depression Inventory and Hamilton Rating Scale for Depression at baseline and 16 weeks.
Main Results:
- 61% of participants achieved depression remission criteria (Hamilton Rating Scale for Depression ≤7) after 16 weeks.
- Loss of energy and fatigue were the most common persistent symptoms, reported by both remitters and non-remitters.
- These residual symptoms were not predicted by baseline depression severity, anxiety, demographics, or medical factors.
Conclusions:
- Fatigue and loss of energy frequently persist in CHD patients post-depression treatment.
- These persistent symptoms may elevate risks for depression relapse and mortality.
- Developing targeted interventions for these residual symptoms is a critical area for future research.
Objective:
Depression is associated with an increased risk of mortality in patients with coronary heart disease (CHD). The risk may be reduced in patients who remit with adequate treatment, but few patients achieve complete remission. The purpose of this study was to identify the symptoms that persist despite aggressive treatment for depression in patients with CHD.
Methods:
One hundred twenty-five patients with stable CHD who met the DSM-IV criteria for a moderate-to-severe major depressive episode completed treatment with cognitive behavior therapy, either alone or combined with an antidepressant, for up to 16 weeks. Depression symptoms were assessed at baseline and after 16 weeks of treatment.
Results:
The M (SD) Beck Depression Inventory scores were 30.0 (8.6) at baseline and 8.3 (7.5) at 16 weeks. Seventy seven (61%) of the participants who completed treatment met remission criteria (Hamilton Rating Scale for Depression ≤7) at 16 weeks. Loss of energy and fatigue were the most common posttreatment symptoms both in remitters (n = 44, 57%; n = 34, 44.2%) and nonremitters (n = 42, 87.5%; n = 35, 72.9%). These symptoms were not predicted by baseline depression severity, anxiety, demographic, or medical variables including inflammatory markers or cardiac functioning or by medical events during depression treatment.
Conclusions:
Fatigue and loss of energy often persist in patients with CHD even after otherwise successful treatment for major depression. These residual symptoms may increase the risks of relapse and mortality. Development of effective interventions for these persistent symptoms is a priority for future research.
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