Depression in bypass patients: non-drug treatments work

It is a known fact -surgery may mend the body but it may also depress the mind. This is especially true with heart surgery. It is estimated that 1 in every 5 patients who underwent coronary artery bypass graft (CABG) surgery suffer from major depression. Many others may suffer from milder forms of depression. However, it is also a known fact that negative feelings are bad for the heart, thus creating a vicious cycle that delays recovery and reduces quality of life.

According to researchers at the Washington University School of Medicine

“Depression around the time of surgery predicts postoperative complications, longer physical and emotional recovery, worse quality of life and increased rates of cardiac events and mortality [death].”

Thus, the researchers conducted a study which involved 123 CABG patients who developed depressive symptoms within one year of surgery. The patients were randomly assigned to three groups, namely:

• 40 patients were assigned to standard care
• 41 patients received 12 weeks of cognitive behavior therapy which consisted of 50- to 60-minute sessions with a psychologist or social worker involved identifying problems and developing cognitive techniques for overcoming them, including challenging distressing automatic thoughts and changing dysfunctional attitudes.
• 42 patients underwent 12 weeks of supportive stress management, wherein the received counselling from social worker or psychologist coping with stressful life events.

The depressive symptoms were monitored before the therapies, at 3, 6, and 9 months.

The study results show that the two non-drug treatments helped in resolving the depressive symptoms better compared to standard care.

The percentage of patients who experienced depression remission are:

• 71% of patients in the cognitive behavior therapy group
• 57% of patients in the supportive stress management group
• 33% of patients in the usual care group

Cognitive behavior therapy seems to be the best strategy, not only against cardiac surgery-related depression but also secondary psychological outcomes, such as anxiety, hopelessness, and perceived stress. Supportive stress management also showed some benefits against depression, “but it had smaller and less durable effects than cognitive behavior therapy.” In comparison, current standard care is not seem to be that effective in resolving depressive symptoms among CABG patients. A previous study has shown that although the medical needs of heart patients are usually met by standard care, there are non-medical needs that usually go unmet but are nevertheless just as important in clinical outcomes.

In fact, the American Heart Association (AHA) issued a science advisory this year recommending routine screening for depression in cardiac patients.