After Heart Bypass, Cognitive Behavior Therapy Best for Depression

Kathleen Blanchard's picture

A new study shows that patients who suffer depression following coronary artery bypass surgery fare better from cognitive behavior therapy or stress management than patients released to normal physician follow-up.

The researchers found that two forms of counseling - cognitive behavior therapy and supportive stress management – were more effective than conventional physician care for alleviating depression, commonly seen in patients who have coronary artery bypass surgery (CABG). Of the two, cognitive behavior therapy was the better treatment for depression after heart bypass.

Mild forms of depression are common after heart bypass. At least one out of five heart bypass patients experience some form of major depression. The study, published in the April issue of the Archives of General Psychiatry, shows that cognitive behavior therapy and stress management after heart bypass improves quality of life, and reduces mortality.


The study, led by Kenneth E. Freedland, Ph.D., of the Washington University School of Medicine, examined 123 patients who experienced depression within one year of having coronary artery bypass surgery. Forty of the patients received routine care for depression from their physicians. The remaining two groups received either cognitive behavior therapy, or supportive stress management. Symptoms of depression were measured before and after therapy to compare cognitive therapy and stress management to conventional care after coronary artery bypass surgery and alleviation of depression.

Patients who received usual physician care showed the lowest reduction in symptoms of depression (33%), after three months. Seventy-one percent of patients who received cognitive therapy for depression responded to therapy, and fifty seven percent of patients enrolled in the stress management group after coronary artery bypass surgery experienced remission at three months.

According to the authors, "Cognitive behavior therapy was also superior to usual care on most secondary psychological outcomes, including anxiety, hopelessness, perceived stress and the mental (but not the physical) component of health-related quality of life. Supportive stress management was superior to usual care only on some of these measures."

The groups were followed at three, six and nine months. The study showed that at each interval, patients who received therapy for depression after coronary artery bypass surgery experienced improvement in symptoms than those who received usual care after heart bypass. Cognitive therapy was the best treatment for patients with depression after coronary artery bypass surgery.

Arch Gen Psychiatry. 2009;66[4]:387-396.