ORONARY ARTERY BYPASS graft (CABG) surgery is one of the most common and costly medical procedures performed in the United States. 1 Its main indications are the relief of angina and improvement in quality of life. 2 Yet as many as half of post-CABG patients report depressive symptoms in the perioperative period, 3 are more likely to experience a decreased healthrelated quality of life (HRQL) and functional status, 4 continued chest pains, 5,6 and inreased rates of rehospitalization and death following CABG surgery independent of cardiac status, medical comorbidity, or the extent of surgery. [7][8][9][10][11] Although the mechanism whereby depression affects post-CABG outcomes remains unknown, 12 widely generalizable strategies to detect and effectively treat post-CABG depression are of great interest. Several treatment trials for depression have been conducted in cardiac populations, but most achieved less than anticipated benefits with regard to reducing mood symptoms [13][14][15][16][17][18][19] or cardiovascular morbidity. [13][14][15][16]19,20 Moreover, none used the proven effective collabo-rative care approach 21 recently recommended by a National Institutes of Health expert consensus panel. 22 Unlike earlier interventions that used a single antidepressant, 13,15,17,18 counseling modality, 20 or antidepressant in combination with counseling for treating cardiacpatientswithdepression, 14,19 collabo-rative care emphasizes a flexible realworld treatment package that involves active follow-up by a nonphysician care manager who adheres to evidence-based Author Affiliations are listed at the end of this article.

Telephone-based collaborative care for panic disorder and generalized anxiety disorder is more effective than usual care at improving anxiety symptoms, health-related quality of life, and work-related outcomes.

This randomized clinical trial examines the effectiveness of combining an internet support group with an online computerized cognitive behavioral therapy provided via a collaborative care program for treating depression and anxiety vs computerized cognitive behavioral therapy alone, and whether providing computerized cognitive behavioral therapy in this manner is more effective than primary care physicians’ usual care.

Randomized controlled trials have demonstrated the efficacy and cost-effectiveness of using treatment models for major depression in primary care settings. Nonetheless, translating these models into enduring changes in routine primary care has proved difficult. Various health system and organizational barriers prevent the integration of these models into primary care settings. This article discusses barriers to introducing and sustaining evidence-based depression management services in community-based primary care practices and suggests organizational and financial solutions based on the Robert Wood Johnson Foundation Depression in Primary Care Program. It focuses on strategies to improve depression care in medical settings based on adaptations of the chronic care model and discusses the challenges of implementing evidence-based depression care given the structural, financial, and cultural separation between mental health and general medical care.