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Neither Treatment for Depression nor Psychosocial Interventions Improved Event-free Survival Following Myocardial Infarction

Post myocardial infarction treatment for depression, for low perceived social support, or for both offered patients no significant difference in event-free survival compared with those who received no depression or psychosocial interventions and treatment.

Susan M. Czajkowski, PhD, of the National Heart, Lung, and Blood Institute in Bethesda, Maryland, United States and colleagues analysed the outcomes of 1084 female and 1397 male myocardial infarction (MI) patients who received either usual post-MI care or usual care plus treatment for depression or interventions for low perceived social support.

Depressed patients received cognitive behaviour therapy (CBT) while those identified with low perceived social support were treated with CBT techniques supplemented with counselling strategies tailored to address the patients' social and behavioural deficits. Elements of both interventions were used for depressed patients with low perceived social support.

Patients received pharmacotherapy if scoring higher than 24 on the Hamilton Rating Scale for Depression or showing less than a 50% reduction in Beck Depression Inventory scores after 5 weeks. Pharmacotherapy included sertraline hydrochloride ranging from 50 mg to 200 mg per day based on patient need, or an alternative SSRI or nortriptyline hydrochloride chosen according to patient tolerance and response.

After an average of 29 months of follow up the researchers report event-free survival in 75.9% of the usual care and 75.8% in the intervention arm of the study. Additionally, no differences in survival were reported between the psychosocial groups in the treatment arm and the group of patients receiving usual care.

Psychosocial outcomes at 6 months favoured the treatment arms. Patients in the depression group had a mean decrease in Beck Depression Inventory scores of 49% compared with 33% for patients receiving usual care. Patients treated for low perceived social support also showed higher rates of improvement than did patients receiving usual care. However, the researchers found that the benefits of intervention diminished over time with no benefit remaining by 30 months of follow up.

The rates of antidepressant use were 9.1% in the intervention and 4.8% in the usual care groups at baseline and rose to 28% and 20.6% in the treatment and usual care groups, respectively, by the end of follow up. When the investigators analysed the time-dependent effect of antidepressant use they found it was associated with a lower risk of reinfarction and/or mortality.

The research team concludes that psychosocial intervention did not improve the rate of recurrent infarction or mortality. Intervention did, however, impart significant improvements in depression and low perceived of social support indices during the first 6 months of therapy.
JAMA 2003;289:3106-3116.

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