Therapy, medication equally reduce depressive symptoms for people with heart failure

Key takeaways:

• Behavioral therapy and medication can equally reduce depressive symptoms for people with HF.
• Patients who received behavioral activation therapy vs. medication had slightly higher health-related quality of life.

Among patients with HF and depression, treatment with behavioral activation therapy or antidepressant medication reduced symptom severity by nearly half within 6 months, researchers reported.

“Patients with HF who are experiencing depression now have a choice of either doing behavioral activation therapy or taking antidepressants,” Waguih W. IsHak, MD, FAPA, professor and vice chair at the department of psychiatry and behavioral neurosciences at Cedars-Sinai Health System, and clinical professor of psychiatry at the David Geffen School of Medicine at the University of California Los Angeles, told Healio. “Since this study found that their effectiveness is comparable, they no longer have to be routinely placed on antidepressant medications and could work with a therapist or coach to develop a personalized list of activities that bring them joy and fulfillment on a regularly scheduled basis, such as connecting with friends, taking walks, volunteering, listening to favorite music or watching favorite shows.”

 In a comparative effectiveness trial, IsHak and colleagues analyzed data from 416 inpatients and outpatients diagnosed with HF and depression from 2018 to 2022. The mean age of patients was 61 years; 58% were men and 56% were white. The researchers randomly assigned patients to one of two treatments: behavioral activation, an evidence-based manualized treatment for depression, promoting engagement in personalized pleasurable activities selected by patients (n = 208); or medication, with care managers providing coordination with patients, psychiatrists and primary care physicians to only administer antidepression medications (n = 208).

“We incorporated the American Psychological Association antidepressant guidelines and World Health Organization antidepressant equivalence dosing guidelines to address the issue of using a variety of antidepressants to avoid limiting the trial to a single antidepressant, which would not only contradict clinical practice but also would limit the research to one medicine that might not suit every patient due to side effects, drug-drug interactions and efficacy,” the researchers wrote.

The researchers also enrolled patient-identified family or friend caregivers to measure caregiver burden.

The primary outcome was depressive symptom severity at 6 months, measured using the nine-item Patient Health Questionnaire (PHQ-9). Secondary outcomes included physical and mental health-related quality of life, measured using the SF-12 version 2; HF-specific health-related quality of life, measured using the Kansas City Cardiomyopathy Questionnaire; caregiver burden, measured with the Caregiver Burden Questionnaire for Heart Failure; ED visits; readmissions; days hospitalized; and mortality at 3, 6 and 12 months.

The findings were published in JAMA Network Open.

At baseline, the mean PHQ-9 scores were 14.54 in the behavioral activation group and 14.31 in the medication-only group.

Researchers found that depressive symptom severity was reduced at 6 months by nearly 50% for patients in the behavioral activation group (mean PHQ-9 score, 7.53; P vs. baseline < .001) and for those in the medication-only group (mean PHQ-9 score, 8.09; P vs. baseline < .001), with no significant difference between groups (P = .88).

Patients in the behavioral activation group experienced a small improvement in physical health-related quality of life measures at 6 months compared with the medication-only group, with mean SF-12 physical scores of 38.82 vs. 37.12, respectively (P = .04). Patients in the behavioral activation group also experienced fewer ED visits at 3, 6 and 12 months and spent fewer days hospitalized at 3, 6 and 12 months compared with the medication-only group.

There were no statistically significant differences between the two groups in mental health-related quality of life, HF-specific health-related quality of life or caregiver burden at 3, 6 or 12 months. There were no statistically significant differences in mortality between the two groups at any time points, based on Kaplan-Meier survival plots. Findings did not change in subgroup analyses defined by depressive symptom severity, PHQ score, HF type or HF symptom severity.

“Behavioral activation therapy, an evidence-based treatment for depression, which promotes engagement in personalized pleasurable and rewarding activities, is as effective as antidepressants medications in the treatment of patients with HF who are experiencing depression,” IsHak told Healio. “Added benefits for behavioral activation included less frequent ED visits, fewer days hospitalized, and slightly more physical quality of life improvements compared to antidepressants.”

Reference:

• Therapy versus medication: comparing treatments for depression in heart disease. https://www.eurekalert.org/news-releases/1031408. Published on Jan. 17, 2024. Accessed on Jan. 17, 2024.

For more information:

Waguih W. IsHak, MD, FAPA, can be reached at waguih.ishak@cshs.org