Depression in Heart Failure: Data Support Psychotherapy or Medication Intervention

A recent comparative effectiveness trial has unveiled a transformative approach to tackling the pervasive issue of depression in patients with heart failure (HF). Conducted over 4 years, the findings not only underscore the efficacy of 2 major interventions—Behavioral Activation Psychotherapy (BA) and Antidepressant Medication Management (MEDS)—but also support patient autonomy in choosing their preferred path to mental well-being.

HF, affecting over 6 million adults in the US and 64 million globally, takes a toll not only on the physical well-being of patients but also on their mental health, with a staggering 50% prevalence of depression, the study stated.

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Recognizing the lack of information on effective interventions, the study aimed to investigate and compare the efficacy of the 2 interventions in addressing depression among patients diagnosed with HF by providing insights into which intervention would be more effective in reducing depressive symptoms and improving patient-centered outcomes. The researchers sought to fill the existing knowledge gap and offer valuable information to patients and clinicians regarding the most suitable interventions for managing depression in these patients.

The first intervention BA is a manualized treatment encouraging engagement in personalized pleasurable activities, with MEDS, utilizing a collaborative care model involving care managers, psychiatrists, and primary care physicians. The primary outcome was depressive symptom severity at 6 months, measured by the Patient Health Questionnaire 9-Item (PHQ-9), with various secondary outcomes ranging from quality of life to emergency department (ED) visits and mortality at different intervals.

The results demonstrated both BA and MEDS recipients experienced an impressive 50% reduction in depressive symptoms at 3, 6, and 12 months, with no statistically significant differences between the 2 groups (P = .55) with mean scores of 7.62 and 7.98, respectively. However, researchers noted that BA recipients showcased added benefits—improved physical quality of life, fewer ED visits, and reduced hospitalization days compared with their MEDS counterparts.

The findings included 416 participants, with the mean age being 60.71 years, and a male representation of 58.41%. The study, conducted from 2018 to 2022, meticulously analyzed data from a diverse demographic, socioeconomic, cultural, and geographic background.

Further analysis at the 6-month milestone revealed that the PHQ-9 mean scores for the BA and MEDS groups were 7.53 and 8.09, respectively, reaffirming the absence of a statistically significant difference (P = 0.88). Delving into the secondary outcomes, the analysis of quality of life, assessed using the Short-Form 12-Item version 2 (SF-12), disclosed a small yet significant improvement in the physical health-related quality of life for the BA group at the 6-month interval. Specifically, the BA group exhibited a mean SF-12 physical score of 38.82, compared with the MEDS group's score of 37.12 (P = 0.04).

Beyond depressive symptomatology, the study investigated health care utilization metrics. ED visits for the BA group saw a reduction of 38%, 30%, and 27% at 3, 6, and 12 months, respectively, compared with the MEDS group (P = 0.005, P = 0.008, P = 0.001, respectively). Similarly, days hospitalized demonstrated a reduction of 17%, 19%, and 36% for the BA group at 3, 6, and 12 months, respectively, relative to the MEDS group (P = 0.002, P = 0.005, P = 0.001, respectively).

In conclusion, these data suggest a paradigm shift in treating depression in patients with HF. With comparable efficacy and the added advantages of BA, the researchers propose that patients with HF be given the autonomy to choose between BA and MEDS. This move toward personalized care acknowledges individual preferences, potentially introducing a new era in mental health interventions for individuals living with HF.

Reference

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