Therapy Versus Medication: Comparing Treatments for Depression in Heart Disease

New research by investigators from the Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai shows that behavioral activation therapy is as effective as antidepressant medications in treating symptoms of depression in patients with heart failure.

Heart failure affects nearly 6 million adults in the United States, and approximately 50% of heart failure patients experience symptoms of depression along with their condition.

Past studies show patients with heart failure and depression have lower cardiac function, more emergency department visits and hospital admissions, higher caregiver burden, and poorer quality of life compared with patients with heart failure who are not depressed.

The study, which was published in the peer-reviewed journal JAMA Network Open, followed more than 400 patients over the course of a year.

Half of the study participants received antidepressant medication management to treat depression symptoms while the other half participated in behavioral activation psychotherapy, an evidence-based treatment for depression that promotes engagement in activities a patient finds enjoyable.

Investigators say there was no statistically significant difference between the effectiveness of the two methods, with each patient group experiencing a more than 50% reduction in the severity of depressive symptoms.

Study participants randomized to receive behavioral activation therapy worked with a therapist to develop a personalized list of activities that bring them joy and fulfillment, including having lunch with a friend, taking a walk, volunteering, listening to their favorite music — among other options — on a regularly scheduled basis.

The treatment focused on increasing the level of enjoyable and rewarding activities the patient was doing every week for 12 weeks, and then incorporating them into their regular activity schedule.

Patients who received psychotherapy intervention showed a slight improvement in their physical and mental health-related quality of life, a secondary outcome monitored by the study.

They also had fewer emergency department visits and spent fewer days hospitalized during the course of the study compared with the patients who were randomized to receive antidepressant medications.


Waguih William IsHak, Michele A. Hamilton, Samuel Korouri, Marcio A. Diniz, James Mirocha, Rebecca Hedrick, Robert Chernoff, Jeanne T. Black, Harriet Aronow, Brigitte Vanle, Jonathan Dang, Gabriel Edwards, Tarneem Darwish, Gabrielle Messineo, Stacy Collier, Mia Pasini, Kaleab K. Tessema, John G. Harold, Michael K. Ong, Brennan Spiegel, Kenneth Wells, Itai Danovitch. Comparative Effectiveness of Psychotherapy vs Antidepressants for Depression in Heart Failure. JAMA Network Open, 2024; 7 (1): e2352094 DOI: 10.1001/jamanetworkopen.2023.52094

Cedars-Sinai Medical Center. (2024, January 17). Therapy versus medication: Comparing treatments for depression in heart disease. ScienceDaily. Retrieved January 18, 2024 from

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