Early Cognitive Behavioral Therapy for Depression After Cardiac Surgery

Abstract

Background Despite high rates of post-cardiac surgery depression, studies of depression treatment in this population have been limited. Objective To evaluate early cognitive behavioral therapy (CBT) in a home environment in patients recovering from cardiac surgery. Methods From July 2006 through October 2009, we conducted a randomized controlled trial and enrolled 808 patients who were screened for depressive symptoms using the Beck Depression Inventory (BDI) in the hospital and one month later. Patients were interviewed using the Structured Clinical Interview for DSM-IV (SCID-I); those who met criteria for clinical depression (n=81) were randomized to CBT (n=45) or usual care (UC; n=36). After completion of the UC period, 25 individuals were offered later CBT (UC+CBT). Results Main outcomes (depressive symptoms [BDI] and clinical depression [SCID-I]) were evaluated after 8 weeks using intention-to-treat principles and linear mixed models. In the CBT group compared to the UC group, there was greater decline in BDI scores (β=1.41 [95% CI 0.81–2.02], p = <.001) and greater remission of clinical depression (29 [64%] vs. 9 [25%], number need to treat, 2.5 [95% CI, 1.7–4.9], p < .001). Compared to the early CBT group, (median time from surgery to CBT = 45.5 days) the later UC+CBT group (median time from surgery to CBT = 122 days) also experienced a reduction in BDI scores, but the group x time effect was smaller (β=0.79 [95% CI 0.101.47], p = .03) and remission rates between the two groups did not differ. Conclusions Early home CBT is effective in depressed post-cardiac surgery patients. Early treatment is associated with greater symptom reduction than similar therapy given later after surgery.

Cognitive Behavioral Therapy in Depressed Cardiac Surgery Patients

“…14 Although there are only a limited number of studies on the effect of CBT in cardiac surgery patients, 15-17 CBT has been reported to be safe and equally effective to antidepressants in reducing depressive symptoms in medical patients. 25,26 CBT has also been shown to produce longer-lasting improvement with low relapse rates than antidepressants and to enhance the efficacy of antidepressants in combination treatment.…”

“…The study methods have been described in greater detail elsewhere. 17 The primary study was conducted at five tertiary care centers in California, USA and was approved by the institutional review board.…”

“…Details regarding the intervention and methods used to ensure fidelity and consistency of the intervention have been described elsewhere. 17 …”

“…Therefore, we conducted a secondary analysis of data from a clinical trial testing the effect of nurse-guided CBT compared with usual care on depressive symptoms among patients recovering from cardiac surgery. 17 Specifically, the aim of the present study was to examine whether the effect of CBT on depressive symptoms is different between cardiac surgery patients with low EF (< 40%) and those with preserved EF (≥ 40%).…”

“…Yet, there are only a few studies that examined the effect of CBT in cardiac surgery patients. 15-17 These studies showed that 4 to 12 sessions of individual CBT resulted in greater improvements in depressive symptoms and quality of life compared to usual care or supportive stress management among patients who underwent cardiac surgery.…”