A Cochrane [Abstract]1 review included 37 studies examining the effect of psychological or pharmacological interventions on depression in subjects with coronary artery disease. Fifteen studies investigated psychological treatments, and 21 studies investigated pharmacological interventions including antidepressant drugs. No studies compared a psychological intervention to a pharmacological intervention.
Psychological interventions reduced end-of-treatment depression symptoms compared to controls (SMD −0.55, 95% CI −0.92 to −0.19, I2 =88%; 10 studies, n=1 226). No effect was evident on medium-term depression symptoms 1 to 6 months after the end of treatment (SMD −0.20, 95% CI −0.42 to 0.01, I2 =69%; 7 studies, n=2 654). Psychological interventions resulted little to no difference in end-of-treatment depression remission (OR 2.02, 95% CI 0.78 to 5.19, I2 =87%; 3 studies, n=862). Based on 1 to 2 studies per outcome, the evidence was uncertain or sparse for the effects of psychological interventions versus usual care on mortality and cardiac events in the short to longer term.
Pharmacological intervention had a large effect on end-of-treatment depression symptoms (SMD −0.83, 95% CI −1.33 to −0.32, I2 =90%; 8 studies, n=750) and a moderate to large increase in end-of-treatment depression remission (OR 2.06, 95% CI 1.47 to 2.89, I2 =0%; 4 studies, n=646) compared to placebo. An effect favouring pharmacological intervention versus placebo on depression response, defined as a 50% reduction in depression scores, at the end of treatment was observed (OR 2.73, 95% CI 1.65 to 4.54, I2 =62%; 5 studies, n=891). No beneficial effects regarding mortality and cardiac events were consistently found.
Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment and blinding, selective outcome reporting) and by inconsistency (statistical heterogeneity).
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