Blog | Thursday, August 2, 2012

QD: News Every Day--Drugs, exercise work for depression among heart disease patients

Exercise or antidepressant medications (but not placebos) worked equally well to treat the depressive symptoms associated with coronary heart disease, a study showed.

Both exercise and sertraline resulted in greater reductions in depressive symptoms compared to placebo in patients with coronary heart disease. Evidence that active treatments may also improve cardiovascular biomarkers suggests that they may have a beneficial effect on clinical outcomes as well as on quality of life, researchers concluded.

Results appeared in the Journal of the American College of Cardiology.

101 outpatients with coronary heart disease and symptoms of depression underwent a psychiatric interview and the Hamilton Rating Scale for Depression. Participants were randomized to four months of aerobic exercise three times a week for 30 minutes), sertraline (50 to 200 mg/day), or placebo.

After 16 weeks, all groups showed improvement on Hamilton Rating Scale for Depression scores. Participants in both the aerobic exercise (mean -7.5; 95% confidence interval [CI], -9.8 to -5.0) and sertraline (mean -6.1; 95% CI, -8.4 to -3.9) groups achieved larger reductions in depressive symptoms compared with those receiving placebo (mean -4.5; 95% CI, -7.6 to -1.5; P=0.034).

Exercise and sertraline were equally effective at reducing depressive symptoms (P=0.607). Exercise and medication tended to result in greater reductions in heart rate variability compared with placebo (P=0.052), and exercise had a greater effect for this than sertraline (P=0.093).

The authors noted that although the sample was small, 40% of patients with major depressive disorder at the time of randomization were remitted at the end of 16 weeks of exercise, compared with 10% of those who received sertraline and none of the patients who received placebo.

An editorial noted that drugs have side effects, as noted in the trial, that exercise has a known benefit among heart disease patients while antidepressants don't, and that exercise may also relieve fear and anxiety of future heart events by offering a sense of empowerment.

But supporting an exercise regimen may require more assistance than doctors can provide in daily practice, and there is no third-party support for it either, the editorial continued.