Benefits and Costs of Improving Depression Treatment in People With Heart Disease: Comment on “Centralized, Stepped, Patient Preference–Based Treatment for Patients With Post–Acute Coronary Syndrome Depression”

In this issue of JAMA Internal Medicine, Davidson et al¹ describe the benefits of an organized depression care program for outpatients experiencing significant symptoms of depression after acute coronary syndrome (ACS). Patients were screened 2 to 6 months after hospitalization for ACS, and those with significant depressive symptoms were randomly assigned to either a systematic depression treatment program or continued usual care (which might include depression treatment from local medical or mental health providers). The Comparison of Depression Interventions after Acute Coronary Syndrome (CODIACS) treatment program included the essential elements proven effective in previous collaborative care or depression care management programs: availability of antidepressant pharmacotherapy and structured psychotherapy, systematic assessment of outcomes, a stepped care algorithm for treatment adjustment or intensification, and organized supervision by consulting mental health specialists. Those offered the organized depression treatment program experienced significantly greater improvement (both statistically and clinically) over 6 months. This finding adds to the substantial evidence for the clinical benefit of depression screening and systematic treatment among people with varying stages of heart disease ranging from outpatients with poorly controlled cardiovascular risk factors² to patients discharged after revascularization.³