Treating depression after surgery speeds recovery

ORLANDO (Reuters Health) - A simple telephone intervention improved mood, physical functioning, and overall quality of life in patients who were depressed after heart bypass surgery, researchers reported in a late breaking clinical trial here at the American Heart Association Scientific Sessions 2009.

In the so-called Bypassing the Blues trial, 50 percent of patients who were depressed after having coronary artery bypass surgery saw improvements of at least 50 percent in their negative mood after participating in the intervention, compared with 29 percent of control patients who received usual care.

Depressed men benefited most and were far less likely to be re-hospitalized for heart-related causes than men who got usual care, said study presenter Dr. Bruce L. Rollman, from the University of Pittsburgh, Pennsylvania.

Depression after heart surgery "is often unrecognized," Rollman noted. When a patient still has symptoms, such as pain, the physician will order another stress test or other heart test "and they overlook the obvious sometimes. We just want people to be aware of the impact of depression and that there are safe and effective treatments available."

In the trial, researchers screened heart bypass patients for depression before they were discharged from the hospital. Screen-positive patients were contacted again two weeks later when they were at home to see if their depression was persisting. If so, they were randomly allocated to receive an 8-month course of telephone-delivered collaborative care or usual care.

Patients in the collaborative care group received a workbook, mailed to them at home, which contained basic "talk therapy" approaches as well as recommendations for exercising, getting plenty of quality sleep, and staying connected socially.

Antidepressants were provided if patients felt it necessary. Patients who were already taking antidepressants could have their dose changed or could switch to another medication, and suggestions were made for consults with local mental health specialists if patients were not improving, Rollman said.

Trained nurse practitioners phoned the patients every other week at the start of the intervention and then once a month as the study progressed.

This simple intervention proved effective in relieving depression after heart bypass surgery, Rollman reported.

Patients should be screened for depression after heart bypass surgery, he said, because it occurs in roughly 25 percent of cases, and, as this study shows, treating depression speeds recovery.

"Many practices have care managers for helping people with their diabetes and other chronic conditions and a similar program could be used to help patients who are depressed cope after their bypass surgery," Rollman said.

The study findings are to be published in the Journal of the American Medical Association.