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Symptoms that remain after depression treatment in patients with coronary heart disease
Robert M Carney1, Kenneth E Freedland1, Brian C Steinmeyer1
1Departments of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
Insights
Residual depression symptoms, common in patients with coronary heart disease (CHD), include fatigue and loss of interest. Pre-treatment anxiety predicts these persistent symptoms, highlighting a need for improved depression treatments in CHD patients.
Area of Science:
- Cardiology
- Psychiatry
- Clinical Psychology
Background:
- Residual symptoms after major depression treatment increase relapse risk in medically well patients.
- These symptoms also predict major adverse cardiac events in patients with coronary heart disease (CHD).
Purpose of the Study:
- To determine the prevalence of residual depression symptoms in depressed patients with CHD.
- To identify predictors of these residual symptoms in patients with comorbid depression and CHD.
Main Methods:
- Combined Beck Depression Inventory-II data from two randomized clinical trials and one uncontrolled treatment study.
- Analyzed data from depressed patients with CHD to identify residual symptom prevalence and predictors.
Main Results:
- The most common residual symptoms were loss of energy, loss of pleasure, loss of interest, fatigue, and difficulty concentrating.
- Pre-treatment anxiety severity predicted the persistence of most residual symptoms, except for loss of energy.
Conclusions:
- Post-treatment residual depression symptoms in CHD patients mirror those in medically well populations, suggesting treatment resistance.
- There is a critical need for developing more effective treatments for these persistent symptoms across diverse patient groups.
Objective:
Symptoms which commonly remain after treatment for major depression increase the risk of relapse and recurrence in medically well patients. The same symptoms predict major adverse cardiac events in observational studies of patients with coronary heart disease (CHD). The purpose of this study was to determine the prevalence and predictors of residual depression symptoms in depressed patients with CHD-.
Methods:
Beck Depression Inventory-II data from two randomized clinical trials and an uncontrolled treatment study of depression in patients with CHD were combined to determine the prevalence and predictors of residual symptoms.
Results:
Loss of energy, loss of pleasure, loss of interest, fatigue, and difficulty concentrating were the five most common residual symptoms in all three studies. They are also among the most common residual symptoms in medically well patients who are treated for depression. The severity of pre-treatment anxiety predicted the post-treatment persistence of all these symptoms except for loss of energy.
Conclusions:
The most common post-treatment residual symptoms found in this study of patients with coronary heart disease and comorbid major depression are the same as those that have been reported in previous studies of medically-well depressed patients. This suggests that they may be resistant to standard depression treatments across diverse patient populations. More effective treatments for these symptoms are needed.
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