Counseling Cheers Depressed Heart Attack Patients

But it doesn't improve survival rates, study finds

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TUESDAY, June 17, 2003 (HealthDayNews) -- Psychological counseling can help heart attack patients deal with the depression they often experience, but it doesn't improve survival or reduce the odds of a second attack, says a new study.

Researchers reached those conclusions after following up nearly 2,500 heart attack patients from 73 hospitals for an average of 29 months. They publish their findings in the June 18 issue of the Journal of the American Medical Association.

The Enhancing Recovery in Coronary Heart Disease Patients trial, funded by the National Heart, Lung, and Blood Institute, was conducted from late 1996 through April 2001. The patients, average age 61, were assigned to a "usual care" group or an intervention group.

Three-quarters of the subjects had depression, with the other quarter suffering from what they perceived as low social support. Both conditions are associated with higher death rates and subsequent heart problems in cardiac patients, previous studies have found.

And depression in heart attack patients is common, as the researchers note in their report. About 20 percent have severe depression and another 27 percent have minor depression.

So the researchers set out to find whether treating that depression and improving perceived social support -- the patient's feeling that he could turn to many loved ones for help -- would reduce the death rate from heart attack and decrease the risk of having a repeat attack.

Those in the intervention group, besides receiving the same care as the "usual care" group, also got weekly individual counseling sessions, sometimes supplemented by group sessions, designed to help them stop negative thoughts and reduce stress. Antidepressants were prescribed to those who needed them in both groups, with 20 percent of the usual care and 28 percent of the intervention group using antidepressants by the study's end.

"There was significant improvement in depression after six months of counseling," says Susan M. Czajkowski, a researcher at the National Heart, Lung, and Blood Institute and project officer of the study. The patients' perception of their social support improved, too.

But at the end of the follow-up, 75.9 percent of the usual care group survived, versus 75.8 percent of those who got counseling.

"We are going back and taking a good in-depth look at the data," Czajkowski says. The lack of benefit on survival and subsequent heart attack was not expected, she says.

Why did the usual care group do better than expected? "We suspect that the patients in the usual care group may have gotten some counseling on their own, or their doctors may have referred them," Czajkowski says. And, she notes, the rate of antidepressant use was fairly similar between the two groups.

But the improvement in depression and social functioning in those who got counseling shouldn't be downplayed, she says. "Even though there was no difference in survival, we did make a difference in terms of the depression and their social functioning," she says.

The study, the largest controlled trial of psychotherapy for heart patients, is an accomplishment in itself, says Nancy Frasure-Smith, a professor of psychiatry at McGill University and the Montreal Heart Institute who co-authored an editorial accompanying the study.

"We may never know whether treating depression can affect the cardiac prognosis," she says. "That isn't as important as encouraging trials to improve the treatment of depression."

While many doctors know to be on the lookout for depression in heart attack patients, Czajkowski advises patients or their loved ones to be aware of the signs of depression and ask for help. Those symptoms include a downcast mood for two weeks or more, loss of energy, feelings of worthlessness and a loss of appetite.

More information

Learn how depression may worsen high blood pressure from the American Heart Association. For more information on depression after a heart attack, visit the American Academy of Family Physicians.

SOURCES: Susan M. Czajkowski, Ph.D., researcher and project officer, National Heart, Lung, and Blood Institute, Bethesda, Md.; Nancy Frasure-Smith, Ph.D., professor, psychiatry, McGill University and Montreal Heart Institute, Montreal; June 18, 2003, Journal of the American Medical Association
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