Traiter une dépression consécutive à une opération du cœur

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This is the first randomized controlled trial evidencing the efficacy of psychotherapy in treating heart surgery patients with chronic depression.

An American randomized controlled trial published in 2009 by Freedland and colleagues in the Archives of General Psychiatry assessed the efficacy of two psychotherapy treatments for depression in coronary bypass surgery patients. Cognitive behavior therapy and supportive stress management proved more efficacious than usual care in alleviating post-surgery depression.

The Study Rationale

20% of coronary artery surgery patients suffer from severe depression. 50% experience depressive symptoms. Depression predicts post-surgery complications (e.g., infections, etc.), longer physical and emotional recovery, and increased mortality rates. The authors proposed to assess the efficacy of cognitive behavior therapy and supportive stress management in alleviating depressive symptoms and improving the patients’ quality of life.

The Question

Is psychotherapy useful to treat post-heart surgery depression?

The Protocol

This randomized controlled trial assessed the efficacy of cognitive behavior therapy and supportive stress management in patients aged over 21 years who had undergone coronary bypass surgery within the previous year. 123 patients were randomly assigned to three groups. 41 of them underwent cognitive behavior therapy (CBT), receiving one individual session of one hour maximum per week for 3 months (brief phone support was allowed). 42 patients were included in a stress management intervention (providing education in stress management, relaxation, breathing, mental imagery techniques) with one weekly session of one hour maximum for 3 months (brief telephone contacts were also permitted). 40 patients received usual care, i.e., no psychotherapy. Use of antidepressant medication was not an exclusion criterion, as long as patients had been taking a therapeutic dose for more than 6 weeks. Medicated patients were represented equally in each group so results could not be biased.

Main Results

At the end of the non-pharmacological interventions and at nine months thereafter, the results evidenced a significant improvement of depressive symptoms in the CBT and stress management groups. Three months after the intervention, depression remission rates were 2.6 and 4.1, respectively. CBT also reduced anxiety levels, feelings of loneliness and perceived stress. The stress management group obtained similar results, with a greater number of dropouts due to the fact that patients had understood the techniques within 4 to 6 weeks and preferred not to attend all 12 sessions. The effect was less durable for the stress management group than for the CBT group. Neither intervention had an effect on the neuropsychological tests results, but patients seem to perceive less cognitive impairment.

What it means for Patients

In 30% to 50% of cases, heart surgery causes depression. It can be treated with a dozen sessions of cognitive behavior therapy or stress management education.

What it means for Healthcare Professionals

CBT- or stress management-based psychotherapy indisputably increases the depression remission rates of coronary bypass surgery patients.

What it means for Researchers

This was the first randomized controlled trial to evidence the efficacy of cognitive behavior therapy and stress management interventions for coronary bypass surgery patients.

What it means for Policymakers

Heart surgery causes depression in 50% of cases. However, depression can be treated efficaciously with 3 months of specialized therapy.

 The Reference

Freedland KE, Skala JA, Carney RM, Rubin EH, Lustman PJ, Davila-Roman VG, Steinmeyer BC, Hogue CW (2009). Treatment of depression after coronary artery bypass surgery: A randomized controlled trial. Archives of General Psychiatry, 66, 387-396.

To reference this Blog en Sante © article.

Ninot G (2014). Treat a depression following heart surgery. Blog en Sante, A36.

© Copyright 2014 Grégory Ninot. All rights reserved.

Thanks to Syl Billere for the English Revision.