- About
half of all people with heart failure in the United States also have
depression.
- Researchers
report that behavioral activation therapy as well as antidepressants can
help improve depressive symptoms.
- Behavioral
activation therapy is an evidence-based treatment for depression that
focuses on the patient’s engagement in enjoyable activities.
Behavioral activation therapy is as
effective as antidepressants for treating depression in
people with heart failure, according to a new study published
in the journal JAMA Network Open.
The researchers noted
that in the United States, there are approximately 6 million adults with heart failure.
About half of them experience symptoms of depression.
The researchers said
people with both heart failure and depression have lower cardiac function, more
emergency room visits, more hospital admissions, higher caregiver burden, and a lower quality of
life compared to people with heart failure without depression.
Details
from the heart failure and depression study
The researchers, who
were from the Department of Psychiatry and Behavioral Neuroscience at
Cedars-Sinai Medical Center in Los Angeles, followed 416 people for one year to
determine if there was a difference in outcome when either behavioral
activation therapy or antidepressants were used to treat depression in people
with heart failure.
Half of the study
subjects received antidepressants and half participated in behavioral
activation therapy. There were no statistical differences in demographic
characteristics between the two groups.
Participants receiving behavioral
activation therapy were assigned to meet with a social worker trained to
provide this type of therapy.
Those receiving
antidepressants were assigned to a registered nurse as a care manager to
provide medications.
Both groups received a
50-minute introductory session with their assigned professional and then weekly
sessions for 12 weeks.
During this initial
12-week period, the behavioral therapy group continued to have 50-minute
sessions while the medication group had weekly 15-minute sessions. After the
initial 12 weeks, both groups received monthly sessions for three months,
followed by sessions on as as-needed basis for an additional 6 months.
Sessions were given
via telehealth, reducing the burden of
transportation and time on the patient and caregiver, which researchers said
improved adherence and quality of life without compromising the effectiveness
of the health care.
At the end of the year,
the researchers reported there was no statistical difference in the
effectiveness between the two groups. Both groups had more than a 50% reduction
in the severity of their depressive symptoms.
“This study, which was
conducted in a real-world setting, demonstrates that it is entirely feasible to
incorporate psychiatric treatment into specialty medical care. Integrating
psychiatric treatment into medical care is an effective way to reduce stigma,
increase access, and improve outcomes for people who struggle with mental
health problems alongside their chronic medical conditions,” said Dr. Itai Danovitch, a professor at
Cedars-Sinai Medical Center and a co-author of the study, in a press release. “Most
people who suffer from depression do not receive effective treatment. It is
critical that we increase screening for psychiatric conditions and
ensure that patients have access to high-quality and effective mental health
care.”
Reaction
to the depression treatment study
Dr. Richard Wright, a
cardiologist at Providence Saint John’s Health Center in California who was not
involved in the research, agreed but said he would have preferred that the
study included a control group – one that received standard treatment for heart
failure and possibly an antidepressant but without therapy.
“It is also questionable
whether this is practical. In this country, at least, we have a shortage of
mental health professionals,” Wright told Medical News Today.
“It would be impossible to have every person with heart failure receive an hour
of counseling once a week for 12 weeks. It would be very difficult to find
mental health care to this extent for people on Medicare.”
“Depression has long
been associated with heart failure, so I suggest walking, getting a pet, going to the movies, getting together
with friends, and engaging in other activities they find enjoyable,” Wright said.
“The take-home message
is that depression can be treated, improved, and the improvements
maintained,” he added. “Another benefit of behavioral activation therapy is
that it doesn’t require additional medication. By the age of heart failure,
many people are on several medications and they all have potential interactions with other drugs. Having a
therapy that doesn’t require adding medication is good.”
Understanding
behavioral activation therapy
Behavioral activation
therapy is an evidence-based treatment for depression that promotes engagement
in activities the patient finds enjoyable.
For the study,
participants randomly assigned to this type of therapy worked with a therapist
to develop a personalized list of activities that brought them joy and
fulfillment.
Examples of activities
include:
- Having
lunch with a friend
- Taking
a walk
- Volunteering
- Listening
to their favorite music
The subjects
participated in their chosen activities on a regularly scheduled basis.
The treatment focused on
increasing the level of enjoyment and rewarding activities done each week for
12 weeks and incorporating them into their daily schedule.
The researchers reported
that the participants who received the psychotherapy intervention showed some
improvement in their physical and mental health-related quality of life, which
was a secondary outcome of the study.
They also had fewer
emergency department visits and spent less time in the hospital during the
study period than those who received antidepressant medications. There was no
statistical difference in mortality between the groups.
One possible cause for
the fewer emergency room visits and hospitalization stays was that the group
receiving behavioral therapy was encouraged to be physically active to a more
significant degree than the group receiving antidepressants.
No comments:
Post a Comment