Controlling depression in patients with heart failure can improve physical health, social functioning and quality of life, according to a new study by psychiatrists and cardiologists at the University of California – Davis and Duke University schools of medicine.
“Our new study is just the tip of the iceberg, since the relationship between the body and mind is extremely complex,” said Wei Jiang, M.D., senior author of the study and director of the Neuropsychocardiology Laboratory at Duke University Medical Center.
“Researchers and practitioners increasingly recognize that the mind and the body have powerful connections, which is promising since they have been segregated for years. This kind of interdisciplinary research can help find answers to how physical health affects mental health, and vice versa, and inform the development of clinical practices that recognize this approach.”
“The improved endurance measurements were especially striking,” added the study’s lead author, Glen Xiong, M.D., an associate clinical professor of psychiatry and behavioral sciences at UC Davis.
“I think clinicians will be more motivated to both screen and treat depressive symptoms in people with heart failure because of the significant functional improvements.”
For the study, the researchers conducted a secondary analysis on data obtained from the 2008 Sertraline Against Depression and Heart Disease in Chronic Heart Failure (SADHART-CHF) study.
This clinical trial evaluated the efficacy of the antidepressant medication sertraline (Zoloft) in reducing depression and cardiac symptoms among 469 men and women 45 years or older with both heart failure and major depression.
The initial SADHART-CHF results found that sertraline treatment did not significantly differ from a placebo in reducing depression symptoms.
The current study focused on participants’ depression and health status, independent of sertraline.
“We wanted to dig deeper into the health effects in patients whose depression improved over the study period, regardless of their medication use,” said Xiong.
The research team used data from standardized evaluations administered over the course of the 12-week SADHART-CHF study to measure both depression and general health. The Hamilton Depression Rating Scale questionnaire was administered periodically to all study participants to assess the severity of depressive symptoms. Cardiac and general health were determined using the Kansas City Cardiomyopathy Questionnaire and the Short Form Health Survey (completed by 285 study participants) and a six-minute walk test (completed by 378 participants).
Participants whose depression went into remission during the trial intervention had improved physical health scores on a variety of measures, including social limitation, physical limitation, quality of life, symptom frequency, and total symptoms, according to the researchers.
“To put the results in perspective, a five-point change in the Kansas City Cardiomyopathy Questionnaire is clinically significant,” said Xiong. “The patients whose depression was in remission had scores 13 points higher than those who were not in remission.”
Those outcomes were backed up by the Short Form Health Survey, which showed that reduced depression symptoms also improved physical function and general health perception, he noted. The six-minute walk test also showed significant improvements in endurance, as patients with reduced depression could walk on average 154 feet farther than those with major depression.
According to the researchers, these results open up a new avenue of investigation that could lead to therapies that leverage the connections between the mind and the body and help heart-failure patients stabilize their condition.
The researchers also recommend further research to find out why some patients respond to depression medications while others do not.
“There may be underlying genetic or other physiological differences, such as inflammatory markers, that alter the opportunities for treatments to work optimally,” said Xiong. “Knowing that relieving depression can be accompanied by broad physical health benefits, we want to be able to identify ways to make treatment modalities as helpful as possible for as many people as possible, especially for those with serious heart disease.”
The study was published in Circulation: Heart Failure.