NEW ORLEANS – Cognitive-behavioral therapy reduced depressive symptoms and enhanced immune function in a small pilot study of women with depression following coronary artery bypass graft surgery, Lynn V. Doering, D.N.Sc., reported at the annual scientific sessions of the American Heart Association.
Women who received a course of cognative-behavioral therapy (CBT) also experienced significantly fewer colds and other minor infectious illness episodes during 6 months of follow-up than did depressed controls who got usual care, said Dr. Doering, chair of the acute care section in the school of nursing at the University of California, Los Angeles.
An estimated 20% of patients experience major depression following CABG surgery. They have worse outcomes than nondepressed patients post CABG. To learn more about the relationship between depression and immunity after CABG, Dr. Doering and her coinvestigators twice interviewed 52 women post CABG, once at hospital discharge and again 2 weeks later.
Based upon these interviews, 15 patients were diagnosed as having major depression. They were randomized to an 8-week program of individual CBT or usual care, consisting of routine postoperative medical and nursing follow-up, plus a consultation by a psychiatrist.
Depressed controls were found to have significantly fewer circulating natural killer cells and higher levels of inflammatory mediators such as interleukin-6, interleukin-1β, and C-reactive protein than nondepressed patients at both 2 weeks and 6 months after discharge.
In contrast, CBT was associated with moderate to large improvements in natural killer cell count and activity, inflammatory mediators, number of infectious illness episodes, and depressive symptoms.
At 6 months none of the CBT-treated patients remained clinically depressed, whereas three of eight patients in the usual care group met diagnostic criteria for major depression and another had minor depression.
Although the study size was far too small to draw definitive conclusions, the results suggest CBT holds promise for treatment of post-CABG depression as well as for immune enhancement in this immunologically compromised population, she said.