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(140) Personalized Treatment Interventions for Depression in Patients with Heart Failure


Authors:

Waguih IsHak, MD, DFAPA – Professor and Clinical Chief of Psychiatry, Cedars-Sinai Medical Center


Co-Authors:

Presenting Author: Waguih IsHak, MD, DFAPA, Cedars-Sinai Medical Center

Abstract:

Background/Significance: Heart Failure (HF) affects more than 26 million adults worldwide. Depressive symptoms in HF patients have a prevalence of at least 48% (Gottlieb 2004). Due to the heightened prevalence of depression in cardiovascular patients, the American Heart Association (AHA) recommends screening patients for depression (Lichman 2008).


Methods: We conducted a systematic review to identify effective ways to treat depression in heart failure patients and now we are conducting a PCORI-funded trial comparing Antidepressant Medication Management using the Collaborative Care Model to Behavioral Activation Psychotherapy.


Results: SSRIs have been shown to be safe for use in HF, however trials of sertraline and escitalopram, the most commonly prescribed antidepressants inheart disease, have failed to show superiority to placebo in 12-week and 24-month randomized clinical trials (RCTs) respectively (Angermann 2016). However, when antidepressants are delivered in the context of personalized Collaborative Care, their evidence has been well established in HF as demonstrated by high-quality RCTs (Bekelman 2018). CBT effectiveness in the treatment of depression in HF has been demonstrated by high-quality RCTs (Jeyanantham2017). The evidence shows that psychotherapy has been faced with access/compliance challenges due to the nature of HF course. Therefore, remote delivery methods such as telephone/telemedicine/web-based delivery have shown great promise (Mohr 2012). Moreover, personalized psychotherapy such as behavioral activation (BA) which is as effective as CBT (Richards 2016) and requires much less training, seem to be more applicable in this population.


Discussion: C/L psychiatrists are best positioned to make recommendations on evidence-based treatment of depression in heart failure. Successful treatment could have a significant impact on functioning, HRQoL, overall health, caregiver burden, Morbidity (as evidenced by frequency of ED visits, readmissions, total days spent in the hospital), and Mortality.


Conclusion: Treatment of depression in heart failure patients is challenging, however antidepressant medication management in the context of Collaborative Care, as well as remotely delivered psychotherapy such as CBT or BA carry significant potential.

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