A new study released on the JAMA Network Open shows that Psychotherapy and Antidepressants offer equal benefits for heart failure patients with depression. Behavioral activation Psychotherapy (BA) appeared to offer the same results as Antidepressant medications (MEDS) for the management of depression in patients with heart failure.
The study seeks to compare the efficacy of psychotherapy (Behavioral Activation – BA) and pharmacotherapy (antidepressant medication management – MEDS) in addressing depression among HF patients, emphasizing patient-centered outcomes.
Understanding Heart Failure and its Impact
Heart Failure is a chronic condition where the heart struggles to pump blood efficiently, leading to a cascade of health issues. It arises from weakened or stiff heart muscles, resulting in symptoms like fatigue, shortness of breath, and fluid retention.
Congestive heart failure is a specific type of heart failure that demands prompt medical attention. Although the terms “heart failure” and “congestive heart failure” are occasionally used interchangeably, congestive heart failure highlights a situation where fluid buildup occurs and may require more immediate medical intervention.
Heart failure can have a profound impact on various aspects of an individual’s health. Firstly, it leads to a reduced ability of the heart to pump blood efficiently, resulting in inadequate oxygen and nutrient supply to the body’s tissues and organs. This can lead to symptoms such as fatigue, shortness of breath, and swelling in the legs and abdomen.
Additionally, heart failure can affect kidney function, causing fluid retention and contributing to increased stress on the heart. Over time, these changes can lead to complications such as arrhythmias, liver damage, and a compromised quality of life. The severity of heart failure can vary, ranging from mild symptoms to more severe cases that require intensive medical management.
Heart failure (HF), affects over 6 million adults in the US and 64 million globally. Unfortunately, HF patients often grapple with an additional challenge – depression. A staggering 50% of HF patients experience depressive symptoms, contributing to lower cardiac function, increased healthcare utilization, higher caregiver burden, and a diminished health-related quality of life.
Prevention of Heart Failure
Preventing heart failure involves adopting a heart-healthy lifestyle and managing underlying risk factors. Regular exercise, maintaining a healthy weight, and following a balanced diet low in saturated and trans fats can contribute to overall cardiovascular health.
Monitoring and controlling blood pressure, cholesterol levels, and diabetes are crucial in preventing heart failure. Avoiding smoking and excessive alcohol consumption are additional lifestyle modifications that can significantly reduce the risk for heart failure.
Early detection and management of conditions that can contribute to heart failure, such as coronary artery disease, valvular disorders, and infections, are essential. Regular check-ups with healthcare providers, especially for individuals with a family history of heart disease, can aid in identifying risk factors early and implementing preventive measures.
What is Depression?
Depression is a mental health condition that goes beyond feeling sad or having a bad day; it’s a persistent and intense state of sadness and hopelessness that can impact a person’s thoughts, emotions, and daily activities. People experiencing depression often find it challenging to enjoy things they once did, and they may struggle with energy, sleep, and concentration. It’s essential to recognize that depression is a medical condition, and seeking support from healthcare professionals is crucial for understanding and managing its effects.
Overview of Depression in Heart Failure Patients
Depression is a major cause of disability globally, and it poses a significant but often overlooked problem among people with heart failure (HF). The combination of biological and psychosocial factors contributes to depressive symptoms in HF patients, making their health challenges even more difficult.
Depression in individuals with heart failure can worsen the overall impact of the condition. In addition to the emotional toll, depression is linked to negative outcomes in heart failure, increasing the risk of health problems and mortality. Those with heart failure and depression often face reduced heart function, more frequent emergency room visits and hospital stays, increased caregiver burden, and a lower quality of life.
The severity of depressive symptoms is a greater risk factor for a diminished quality of life than the severity of heart failure symptoms alone. Furthermore, depression in heart failure patients is independently associated with a higher risk of declining function and overall mortality.
Despite these significant effects, only half of patients diagnosed with both heart failure and depression receive appropriate treatment, leaving a substantial gap in addressing the mental health aspect of this complex condition. This shows the importance of recognizing and addressing mental health in the overall care of individuals with heart failure.
Comparative Effectiveness Trial
In an effort to bridge this gap, a comparative effectiveness randomized clinical trial was conducted, gaining approval from the Cedars-Sinai institutional review board. Enrolling patients from Cedars-Sinai Health System between 2018 and 2022, the study focused on individuals with HF, depressive symptoms (PHQ-9 score ≥10), and a confirmed DSM-5 depressive disorder diagnosis. The trial compared two interventions – Behavioral Activation (BA) and Antidepressant Medication Management (MEDS) – in a pragmatic fashion, acknowledging the challenges HF patients face in attending in-person sessions. The interventions were delivered via video or telephone by trained professionals.
Key Outcomes and Observations
The study, comprising 416 adults, revealed a significant reduction of nearly 50% in depressive symptoms for both BA and MEDS recipients at 3, 6, and 12 months, with no statistically significant differences between the two treatments. Primary outcomes, such as depressive symptom severity at 6 months (measured by PHQ-9), showed no notable disparity. However, secondary outcomes unveiled intriguing insights. Physical Health-Related Quality of Life (HRQOL) improved more in the BA group at 6 months, with BA patients experiencing fewer Emergency Department (ED) visits and hospitalization days compared to MEDS recipients.
Study Conclusion
In essence, this comparative trial demonstrated the effectiveness of both BA and MEDS in reducing depression among HF patients. While primary depression severity outcomes did not significantly differ, BA demonstrated advantages in certain secondary outcomes, suggesting potential benefits for patients in aspects beyond mental health.
The study’s pragmatic approach and diverse population make its findings widely applicable, providing clinicians and patients with valuable choices for effective depression care in the context of heart failure. Addressing both physical and mental well-being is pivotal in enhancing the overall quality of life for individuals navigating the complexities of heart failure.
Sources
- American Heart Association (2023, March 22). What is Heart Failure? https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure#
- IsHak WW, Hamilton MA, Korouri S, 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
