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Congestive heart failure and depression are 2 common and disabling chronic conditions. When depression occurs in patients with heart failure, which is often, the illness burden and management complexity increase multifold. Freedland et al1 tested the hypothesis that the effective treatment of comorbid depression with cognitive behavior therapy (CBT) would also lead to improvements in heart failure self-care and physical functioning and found it did not. The good news is that CBT did significantly improve emotional health and overall quality of life, and the improvement in depressive symptoms associated with CBT was larger than observed in pharmacotherapy trials for depression in patients with heart disease. This is supportive evidence for a shift in practice away from so much pharmacotherapy and more use of psychotherapy to achieve better mental health and overall quality-of-life outcomes in patients with heart failure. In reframing how we think about the management of depression in patients with heart failure, we should be talking more and prescribing less.
O’Malley PG. Reframing Depression Treatment in Heart Failure. JAMA Intern Med. 2015;175(11):1782. doi:10.1001/jamainternmed.2015.5240