Exercising reaps benefits for people with coronary heart disease who are depressed, review shows

Dr Doyle and his colleagues claim their paper is the first systematic review to compare treatments for depression for people with coronary heart disease.

The researchers focused on treatment trials that investigated the efficacy of antidepressants, psychotherapy, exercise, and combined psychotherapy and antidepressants. Trials based on collaborative care approaches – treatments developed by multidisciplinary clinical teams, with input from patients – were also included.

The research team looked at factors such patients’ adherence to the treatment (or ‘dropout rates’) and changes in patients’ depressive symptoms eight weeks after the onset of treatment. While exercise and combination treatments (antidepressants and psychotherapy) had the strongest treatment effects, the review suggests that exercise is probably the most effective treatment – in part because the combination study results had a high risk of bias.

Antidepressants had the most research support, while psychotherapy and collaborative care did not perform very well.

'Vital' to find the most effective treatments

Dr Doyle, a senior lecturer in the division of population health sciences at RCSI, said: ‘Depression is common in patients with coronary artery disease. Having both conditions can have a significant impact on [their] quality of life … so it is vital that they access to the most effective treatments.’

‘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.’

Conclusions

The paper concludes that the current evidence suggests that ‘although all treatments for post-CAD [coronary artery disease] depression are equally acceptable, the most robust evidence base is for antidepressants, which should be the first treatment option'.

‘Combinations of antidepressants and psychotherapy, along with exercise, could be even more effective than antidepressants alone but require further research before this can be established. Researchers should consider the comparator groups carefully and report them in detail for future evidence synthesis.’

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 [Frank Doyle]

Dr Doyle added: ‘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.’

Review based on new 'hybrid' approach 

Dr Doyle and the study’s senior authors, professors Jan Sorensen, who is also based at RCSI, and Martin Dempster, from Queen’s University Belfast, conducted the study in collaboration with researchers from the USA, the Netherlands, the UK and Denmark.

Their study is said to be the first of its kind to establish a new method to conduct systematic reviews. Known as a hybrid review, it involved a combination of umbrella reviews and systematic reviews.

To download a copy of Hybrid Systematic Review and Network Meta-Analysis of Randomized Controlled Trials of Interventions for Depressive Symptoms in Patients With Coronary Artery Disease visit: https://journals.lww.com/psychosomaticmedicine/Fulltext/2021/06000/Hybrid_Systematic_Review_and_Network_Meta_Analysis.5.aspx