Behavioral Psychotherapy, Antidepressants Yield Minimal Differences in Depression Treatment Coinciding With Heart Failure

Author(s):

Ashley Gallagher, Associate Editor

Investigators determined the effectiveness of behavioral activation psychotherapy versus antidepressant medication management for inpatients with heart failure and depression.

Patients with heart failure (HF) can be given either behavioral activation psychotherapy or antidepressant medication management for the treatment of ameliorate depression, according to results of a clinical trial (NCT03688100) published in JAMA Network Open. In the study, investigators aimed to determine the effectiveness of behavioral activation psychotherapy compared to antidepressant medication management for the outcomes of inpatients with both HF and depression.

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According to the study authors, those who have HF and depression tend to have lower cardiac function, more emergency department (ED) visits, more hospital admissions, and poorer health-related quality of life (HRQOL) compared to patients with only HF. They also reported that approximately 50% of those diagnosed with depression and HF received treatment for depression. Although behavioral activation psychotherapy and antidepressant medications have data supporting their efficacy in those with HF, there is little evidence on which intervention physicians should use to address depression for patients with HF.

About The Clinical Trial

Study Name: Personalized Treatments for Depressive Symptoms in Patients With Advanced Heart Failure

ClinicalTrial.gov ID: NCT03688100

Sponsor: Cedars-Sinai Medical Center

Completion Date: May 2022

Investigators conducted a randomized trial to compare the efficacy of both treatments for the patient population, with interest in depressive symptom severity; physical and mental HRQOL; HF-specific HRQIL; caregiver burden; morbidity, including ED visits, hospital readmission, and days spent in the hospital; and mortality at 3, 6, and 12 months, according to the study authors. The study investigators included individuals who were inpatients admitted to a hospital in the Cedar-Sinai Health System for HF and had depressive symptoms. Patients also had data on outpatients visits for HF follow-up. Investigators excluded individuals if they were already on active treatment for depression, were an imminent danger to themselves or others, experienced cognitive impairment, or had bipolar, psychotic, or substance-induced disorders.

The study investigators assigned either treatment on a 1:1 ratio to patients as well as a licensed social worker as a behavioral activation psychotherapist for the behavioral activation psychotherapy treatment, or a registered nurse for the antidepressant medications care manager. Patients participated in a 50-minute introductory session followed by 12 weekly sessions, then monthly for 3 months, then as needed for an additional 6 months. The interventions were conducted via video or telephone due to the disease burden of HF for patients.

The study authors included 416 individuals in the study with 208 receiving either treatment at random. The average age was 60.71 years, with approximately 58.41% male participants. Approximately 19.33% were African American or Black, 5.05% were Asian, 56.01% were White, and 14.42% were Hispanic or Latinx, according to the study authors. Investigators reported that there was a higher prevalence of atrial fibrillation and use of anticoagulants and digoxin in the behavioral activation psychotherapy group and a higher prevalence of chronic liver disease and history of antidepressant use in the antidepressant medications group.

Investigators found that depressive symptom severity was reduced by nearly 50% at 6 months for both groups, with no significant differences between groups. Furthermore, they reported statistically significant improvements in both groups for outcomes of physical HRQOL, mental HRQOL, and HF-specific QOL at 6 months, with those in the behavioral activation psychotherapy group having a difference higher than the minimal clinically important difference of 2 that was previously established compared to the antidepressant medications group. The 3-month and 12-month data had no statistically significant differences between groups for physical HRQOL.

Further, those who received behavioral activation psychotherapy were significantly less likely to have ED visits at 3, 6, and 12 months compared to those in the antidepressant medications group. Patients in the behavioral activation psychotherapy group spent fewer days in the hospital at all 3 time points compared to the antidepressant medications group. Additionally, there were no significant differences in hospital readmissions or mortality between groups.

The study authors also reported that in subgroup analysis, including baseline depressive symptom severity, HF type, and HF symptom severity, there were no statistically significant differences between the groups in any of the 3 sub-analyses. There were also no significant adverse events related to the study, according to the authors.

Investigators cited limitations, including the fact that there was no control group and they were unable to collect data outside of California, United States, according to the study authors.

Reference

IsHak WW, Hamilton MA, Korouri S, Diniz MA, et al. Comparative Effectiveness of Psychotherapy vs Antidepressants for Depression in Heart Failure: A Randomized Clinical Trial. JAMA Netw Open. 2024;7(1):e2352094. doi:10.1001/jamanetworkopen.2023.52094