Friday, January 19, 2024

Behavioral Activation, Medication Equally Effective for Depression in Patients With Heart Failure

Behavioral activation psychotherapy may be just as effective as antidepressants at reducing symptoms of depression in patients with heart failure, a study in JAMA Network Open has found. Behavioral activation psychotherapy, a form of cognitive-behavioral therapy, encourages patients to engage in activities that they enjoyed before developing depression so as to improve their mood.

“Approximately 50% of people with [heart failure] experience depressive symptoms,” wrote Waguih William IsHak, M.D., of Cedars-Sinai Medical Center in Los Angeles and colleagues. Previous studies show that the greater the severity of depression in people with heart failure, the greater the risk for functional decline or death at six months.

The study included 416 adults (mean age, 61 years) who had been diagnosed with heart failure and depression. The patients were randomized to receive either behavioral activation psychotherapy or antidepressant medications. The patients were followed for up to one year.

Behavioral activation therapists and medication care managers facilitated a 50-minute introductory session with patients followed by 12 weekly sessions, then 3 monthly sessions, then contact as needed for an additional 6 months. Behavioral activation sessions lasted 50 minutes and medication management sessions (which did not include psychotherapy) lasted 15 minutes. All sessions were delivered using video or telephone because patients with heart failure may face challenges that make it harder for them to attend sessions in person. The primary outcome was depressive symptom severity at 6 months, measured using the Patient Health Questionnaire 9-Item (PHQ-9).

At baseline, the patients’ mean PHQ-9 scores were 14.54 in the behavioral activation group and 14.31 in the medication group. At the 6-month follow-up, researchers found that the severity of depressive symptoms decreased by nearly 50% for both groups of patients: The mean PHQ-9 scores were 7.53 in the behavioral activation group and 8.09 in the medication group. At 12 months, the mean PHQ-9 scores were 7.62 in the behavioral activation psychotherapy group and 7.98 in the medication group. Patients in the behavioral activation group also experienced small improvement in physical health–related quality of life at 6 months, had fewer emergency department visits, and spent fewer days in the hospital compared with those in the medication group.

“The improvement in physical health–related quality of life, lower likelihood of [emergency department] visits, and fewer hospitalization days observed in the [behavioral activation] group compared with the [medication] group suggest secondary advantages for [behavioral activation], especially that patients with [heart failure] and depression may be reluctant to add more medications to their already large pill burden,” IsHak and colleagues wrote.

“Our findings demonstrate that both interventions are comparably effective in reducing depression for patients with [heart failure], giving patients, caregivers, and health care practitioners the choice between [behavioral activation] and [medication], thus improving patient-centered depression care in [heart failure],” they concluded.

For related information, see the Psychiatric News article “Collaborative Care Improves Quality of Life in Patients With Heart Failure.”

(Image: Getty Images/iStock/magicmine)

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