Magazine article Clinical Psychiatry News

Addressing Depression Protects Head in Short Term Only

Magazine article Clinical Psychiatry News

Addressing Depression Protects Head in Short Term Only

Article excerpt

AT ACC 13

SAN FRANCISCO -- If ever a study drove home the point that depression--including post--acute coronary syndrome depression--is a chronic relapsing disorder requiring long-term maintenance therapy, it's the COPES trial.

COPES (Collaborative Psychosocial Evaluation Studies) was a randomized, prospective, single-blind trial in which patients with persistent depressive symptoms after an ACS event received 6 months of enhanced, centralized antidepressant therapy or usual care. Six months post randomization, the intervention group showed significantly lower depression scores than controls did, together with an accompanying impressive reduction in the combined endpoint of death, myocardial infarction (MI), or unstable angina.

That's the good news. The COPES message that effective depression treatment appears to reduce the risk of recurrent cardiac events has met with a warm reception.

Now the bad news: A just-completed 2-year follow-up of COPES participants showed that the cardioprotective benefit did not persist. Between 6 months and 2 years, a catch-up phenomenon occurred, such that at the 2-year mark the cumulative cardiac event rate in the intervention and usual care arms was essentially the same, Dr. Siqin Ye reported at the annual meeting of the American College of Cardiology

"The effect of brief enhanced depression therapy after ACS may diminish over time. In future studies we're going to need to examine how the benefits of short-term depression therapy can be sustained long term in post-ACS patients with depression," said Dr. Ye, a cardiologist at the Center for Behavioral Cardiovascular Health of Columbia University Medical Center, New York.

That should not be difficult to accomplish, he said in an interview. The main form of treatment used in COPES, known as problem-solving therapy, can be delivered over the phone or on the Internet, making it amenable to ongoing, periodic, low-cost maintenance therapy sessions.

COPES included 157 patients with persistent depressive symptoms after an ACS event as defined by a Beck Depression Inventory score of 10 or more both during their initial hospitalization and 3 months later. …

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