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Management of depression in patients with coronary artery disease: A systematic review

Wole Akosile1, Babangida Tiyatiye2, David Colquhoun3

  • 1School of Medicine, University of Queensland, Australia; New Farm Clinic.

Asian Journal of Psychiatry
|March 5, 2023
PubMed

Insights

Treatments for depression in coronary artery disease (CAD) patients showed small effects on mood but did not significantly improve heart outcomes. Patient choice improved satisfaction, but more research is needed.

Area of Science:

  • Cardiology
  • Psychiatry
  • Public Health

Background:

  • Comorbid depression significantly impacts coronary artery disease (CAD) prognosis, representing a substantial global health burden.
  • Effective treatment strategies for comorbid depression in CAD patients are crucial for improving patient outcomes.

Approach:

  • Systematic literature review of randomized controlled trials (RCTs) investigating interventions for depression in adults with comorbid CAD.
  • Searched major databases (Cochrane, MEDLINE, EMBASE, PsycINFO, PubMed, CINAHL, ISRCTN) for English-language studies.
  • Extracted data on study design, interventions (psychotherapy, medication), participant characteristics, and outcomes (depression and CAD).

Key Points:

  • Nineteen RCTs were included from 4464 initially identified articles.
  • Antidepressants or psychotherapy did not significantly improve CAD outcomes in the overall population.
  • Psychological and pharmacological interventions offered small improvements in depression symptoms.
  • Aerobic exercise showed no difference compared to antidepressant use for CAD outcomes.
  • Patient autonomy in treatment choice correlated with higher satisfaction but did not impact clinical outcomes.

Conclusions:

  • Current evidence suggests psychological and pharmacological interventions have limited impact on CAD outcomes in depressed patients.
  • Existing studies are often underpowered, highlighting the need for larger, robust trials.
  • Further research should explore novel treatments like neurostimulation and complementary/alternative therapies for this population.

Keywords:
CADCardiovascular diseaseCoronary artery diseaseDepressionMDDPsychopharmacologyPsychotherapy

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