Cognitive behavioral therapy in depressed cardiac surgery patients: role of ejection fraction.

AIMS: The aim of this study was to evaluate the relationship of ejection fraction (EF) and depressive symptoms in cardiac surgery patients assigned to nurse-guided cognitive behavioral therapy (CBT) or usual care (UC). METHODS: Depressive symptoms were assessed using the Beck Depression Inventory (BDI). Seventy-seven patients (31% women; mean [SD] age, 63.6 [9.8] years) received 8 weeks of either CBT or UC. Using repeated-measures analysis of variance, changes in depressive symptoms over time were evaluated. RESULTS: There was a significant interaction among time, treatment group, and EF status (p = 0.019). In the patients with preserved EF (≥40%), mean BDI scores in the UC group worsened by 1.9%, whereas those in the CBT group improved by 31.0%. In the patients with low EF (<40%), mean BDI scores worsened by 26.8% and improved by 75.3% in the UC and CBT groups, respectively. CONCLUSIONS: Nurse-guided CBT is effective in reducing depressive symptoms after cardiac surgery, particularly in patients with low EF.

Early cognitive behavioral therapy for depression after cardiac surgery.

BACKGROUND: Despite high rates of postcardiac surgery depression, studies of depression treatment in this population have been limited. OBJECTIVE: The aim of this study was to evaluate early cognitive behavioral therapy (CBT) in a home environment in patients recovering from cardiac surgery. METHODS: : From July 2006 through October 2009, we conducted a randomized controlled trial and enrolled 808 patients who were screened for depressive symptoms using the Beck Depression Inventory (BDI) in the hospital and 1 month later. Patients were interviewed using the Structured Clinical Interview for DSM-IV; those who met criteria for clinical depression (n = 81) were randomized to CBT (n = 45) or usual care (UC; n = 36). After completion of the UC period, 25 individuals were offered later CBT (UC + CBT). RESULTS: Main outcomes (depressive symptoms [BDI] and clinical depression [Structured Clinical Interview for DSM-IV]) were evaluated after 8 weeks using intention-to-treat principles and linear mixed models. Compared with the UC group, in the CBT group, there was greater decline in BDI scores (ß = 1.41; 95% confidence interval [CI], 0.81-2.02; P = < .001) and greater remission of clinical depression (29 [64%] vs 9 [25%]; number need to treat, 2.5; 95% CI, 1.7-4.9; P < .001). Compared with the early CBT group (median time from surgery to CBT, 45.5 days) the later UC + CBT group (median time from surgery to CBT, 122 days) also experienced a reduction in BDI scores, but the group × time effect was smaller (ß = 0.79; 95% CI, 0.10-1.47; P = .03) and remission rates between the 2 groups did not differ. CONCLUSIONS: Early home CBT is effective in depressed postcardiac surgery patients. Early treatment is associated with greater symptom reduction than similar therapy given later after surgery.