Exercise likely to be best treatment for depression in coronary heart disease

The study, led by researchers at RCSI University of Medicine and Health Sciences, is published in the June edition of Psychosomatic Medicine.

This is the first systematic review to compare treatments for depression in those with coronary disease and the findings provides valuable clinical information to help doctors determine the best treatment plan for patients.

The researchers reviewed treatment trials which investigated antidepressants, psychotherapy, exercise, combined psychotherapy and antidepressants, and collaborative care (i.e. treatments devised by a multidisciplinary team of clinicians with input from the patient).

To measure effectiveness, the researchers looked at factors including patient adherence to the treatment (dropout rate) and change in depressive symptoms eight weeks after commencing treatment.

The strongest treatment effects were found to be exercise and combination treatments (antidepressants and psychotherapy). However, as the combination study results have a high risk of bias, the findings of the review suggest that exercise is probably the most effective treatment. Antidepressants had the most research support, while psychotherapy and collaborative care did not perform very well.

"Depression is common in patients with coronary artery disease. Having both conditions can have a significant impact on the quality of life for patients so it is vital that they access to the most effective treatments," commented Dr Frank Doyle, Senior Lecturer Division of Population Health Sciences, RCSI and the study's first author.

"Our study indicates that exercise is likely to be the best treatment for depression following coronary artery disease. Our findings further highlight the clinical importance of exercise as a treatment as we see that it improves not only depression, but also other important aspects of heart disease, such as lowering blood pressure and cholesterol, in these patients."

"We continue to see emerging evidence of the importance of lifestyle to treat disease -- in comparison to other treatments -- but further high-quality research is needed. People with coronary heart disease who have symptoms of depression should talk to their doctor about treatments that are most suitable for their personal needs, and clinicians can be confident of recommending exercise to their patients."

Dr Frank Doyle and the study's senior authors, Prof. Jan Sorensen (Health Outcomes Research Centre, RCSI) and Prof. Martin Dempster (School of Psychology, Queen's University Belfast), conducted the study in collaboration with researchers in the USA, The Netherlands, the UK and Denmark.

This study was also the first of its kind to establish a new method to conduct systematic reviews known as a hybrid review, which is a combination of umbrella reviews and systematic reviews.