Treating depression after acute coronary syndromeBMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1567 (Published 12 March 2013) Cite this as: BMJ 2013;346:f1567
Depression is common after hospital admission for acute coronary syndrome and international guidelines recommend screening and treatment. A recent trial tested a programme of care that allowed people with depression symptoms to choose between psychotherapy, antidepressant drugs, or a combination of the two. The programme worked well, reducing symptoms significantly more than usual care over six months (an extra 3.5 point drop in Beck depression inventory score, 95% CI −6.1 to −0.7).
All 150 participants had symptoms of depression two to six months after treatment for acute coronary syndrome. Among 73 assigned to the new programme, 41 chose psychotherapy, nine chose drugs, and 17 chose the combination. Their care was organised by a remote team of mental health professionals who met once a week to discuss cases and advise a local doctor or nurse prescriber. A centralised team also provided psychotherapy (problem solving therapy) over the telephone or by video link and followed a stepped care algorithm that intensified treatment every six to eight weeks if required.
This programme contained all the elements known to work from previous trials and introduced the idea that organisation, coordination, and support does not have to be local to be successful, says a linked comment (doi:10.1001/jamainternalmed.2013.925).
Cite this as: BMJ 2013;346:f1567