Depression often accompanies the diagnosis of coronary heart disease with the mood disorder impairing prognosis and quality of life.
A new research review finds that one of the ‘oldest’ forms of medicine, may be the best bet for improving mental and physical health.
The study reviewed nonpharmacological treatments for depression in patients with coronary heart disease (CHD) including psychotherapies, aerobic exercise, St. John’s wort (SJW), acupuncture and additional supplements.
Researchers implemented a comprehensive literature review of published articles using medline searches and bibliographic reviews.
Each treatment was reviewed with particular attention paid to empirical support, as well as to potential mechanisms of action that might affect not only depression but also CHD endpoints.
The literature review discovered that nearly all randomized controlled trials (RCTs) of depression treatments—that is, clinical experiments of the highest quality–have been conducted with non-CHD patients. These studies have provided the most support for psychological treatments, particularly cognitive behavioral and intrapersonal therapies.
Aerobic exercise, Saint John’s Wort, and S-Adenosylmethionine (SAMe) also have considerable empirical support in otherwise healthy persons, but SJW may have undesirable side effects for CHD patients.
Data for essential fatty acids (EFAs), chromium picolinate (CP), and acupuncture are limited; however, the use of aerobic exercise shows considerable promise for cardiac patients.
Unfortunately at this time few RCTs of patients with clinical depression and CHD exsit, and those that are available have significant methodological limitations.
Nonetheless, there is preliminary evidence that nonpharmacologic treatments are effective for cardiac patients with depression.
In terms of reducing depression, the most evidence exists for psychological treatments, particularly CBT and IPT. However, there is little evidence that such treatment would also improve CHD risk factors.
Aerobic exercise offers more promise to improve both mental and physical health due to its effect on cardiovascular risk factors and outcomes and thus warrants particular attention in future trials.
Source: Duke University Medical Center