Depression and perceived grave soci...

Depression and perceived grave social support are associated with increased morbidity and mortality in patients with coronary heart disease (CHD) and depression is an independent risk factor for mortality after myocardial infarction (MI). single in kind trial has shown that depression in post-MI patients can be treated favorably but no trial has shown that treatment improves survival in patients with CHD This randomized, controll multicenter trial was directioned by the committee for the Enhancing convalescence in Coronary Heart Disease Patients trial to determine whether treating depression and increasing social support remodel the risk of recurrent nonfatal MI and death.

Patients with acute MI who were lay the foundation of to be depressed or to have perceived reasonable social support according to a semistructured interview and a social support instrument were eligible for the studious mood Participants received baseline electrocardiography; a medical history and physical examination were obtained; and several depression scales were administered. Patients were randomized to an intervention cluster and a usual-care group. The intervention cluster received cognitive behavior therapy. Patients with perceived soft social support also received a social support assessment, with counseling sessions focusing upon behavior and social skill deficits, cognitive factors contributing to unsatisfactory horizontals of support, and social outreach guidance. Patients who continued to be abashed according to specific criteria were referr after five weeks for consideration of pharmacotherapy.

Patients were given sertraline or an alternative medication (a different selective serotonin reuptake inhibitor or nortriptyline), depending upon tolerability and response to the medication. Behavior therapy continued for up to six month with form into groups therapy permitted to continue an additional 12 weeks and pharmacotherapy an additional 12 month or more as extremityed Follow-up visits occurred six month after randomization and annually thereafter, with primary conclusion points being recurrent MI or death from any cause. Secondary finis points included revascularization and cardiovascular hospitalizations.

Of the 2481 randomized patients, 1243 were assigned to usual care and 1238 to intervention. All patients were followed for at least 18 month Four-year survival 1s showed no significant difference between treatments in the primary or secondary expiration points. The intervention group showed significant however modest improvements in depression and social support compared with the command group. At six months, the mean Beck Depression Inventory score was 91 in the intervention cluster versus 12.2 in the usual-care assign places to (P < .001), with comparable differences in the Hamilton Rating Scale for Depression score. Of 1238 patients, 1145 (92 percent) received the intervention as assigned. Patients attended a median of 11 sessions.

Antidepressant use, which was greater in the intervention form into groups than in the usual-care cluster throughout the duration of the trial, was associated with a lower risk of nonfatal MI or death. According to further analysis, the high rate of antidepressant use in the two groups did not influence the finding that behavior therapy lacked benefit.

The intervention assemblage showed significant improvements in social support and depression without showing any impact in succession cardiac morbidity and mortality close points. The investigators found that antidepressant use was associated with lower infarction and mortality risk, perhaps because of mechanisms independent of the medications' general intent on depression. There may be many reasons for the ineffectual results of this trial, including timing and duration of the intervention, lack of motivation in the patients, the inability to descry an effect in a assign places to already receiving state-of-the-art cardiac care, and possible lack of resources to facilitate participation in behavior therapy.

Previous studies have demonstrated that depression and perceived reasonable social support are independent risk factors for cardiac issues but reversing these conditions may not have sufficient, or any, impact forward the underlying pathophysiology. The authors attract favor to identifying and treating post-MI depression, however, because calm without improved cardiac outcomes, quality of life improves.

Writing Committee for the ENRICHD Investigators. drifts of treating depression and gentle perceived social support on clinical consequences after myocardial infarction. The Enhancing convalescence in Coronary Heart Disease Patients (ENRICHD) randomized trial. JAMA June 18 2003;289: 3106-16

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