Treatment for depression and low social support in patients with recent myocardial infarction does not improves rates of mortality or second infarction but does produces significant gains in mood and social function, according to an article in the June 18th issue of the Journal of the American Medical Association. The current study, Enhancing Recovery in Coronary Heart Disease Patients Study (ENRICHD), was the first major trial to look at both cardiovascular and psychosocial outcomes.

According to background material, depression and patient perceptions of social isolation are risk factors for death and recurrent infarction in patients with heart disease. Roughly 25 percent of heart disease patients have one of these conditions after a myocardial infarction, which places them at a 3-fold to 4-fold higher risk of death.

The current study enrolled 2, 481 patients who were within 28 days of their myocardial infarction. Patients had depression, perceptions of low social support, or both. After random assignment to treatment or usual care, all patients received information on heart disease risk factors. The treatment group also received 6 months of cognitive behavioral therapy. During these sessions, trained counselors provided cognitive therapy to modify or eliminate thought patterns contributing to the patient's symptoms and behavioral therapy to help patients change habits. Some patients from both groups were given antidepressants.

Survival at 29 months was virtually identical in both groups -- 75.9 percent in usual care and 75.8 percent in the treatment group. Interestingly, risk of death or of a second infarction was lower among patients who were taking antidepressant medication regardless of whether they received counseling. However, the authors concluded this finding is not definitive because the study was not specifically designed to test the effects of antidepressants. Future studies will be needed to address this question.

The findings regarding counseling therapy reveal the benefits of treatment on quality of life. At 6 months, depressed patients in the treatment group had a 57 percent reduction in depression compared with a 47 percent reduction in the usual care group. Patients with low social support in the treatment group had a 27 percent improvement compared with an 18 percent improvement in usual medical care participants.

According to Susan Czajkowski, Ph.D., lead investigator and faculty member at the National Institutes of Health, these findings show that treatment can have a significant impact on the psychosocial function of patients who have survived an infarction. She added that the study results offer an important public health message: People who have had a myocardial infarction who show signs of depression should be evaluated and treated according to existing psychiatric guidelines. At present, only an estimated 25 percent of affected Americans are treated for their depression.