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Behavioral activation therapy improved depression symptoms as effectively as antidepressants in people with heart failure. Maskot/Getty Images
  • A new study shows behavioral activation therapy improved depression symptoms as effectively as medication in people with heart failure.
  • Depression is common among people with heart failure and can severely impact their quality of life.
  • Experts say that expanding access to mental health options, especially non-pharmacological interventions, for people with chronic illnesses is an important step.

A type of behavioral therapy appears just as effective as antidepressant medication in treating people with heart failure diagnosed with depression, according to a new study.

The researchers say their work will help expand access to mental health care for this vulnerable population without sacrificing effectiveness. The findings were published January 17 in JAMA Network Open.

Depression is a serious and common comorbidity with heart failure that can negatively affect quality of life and further compound health problems. However, the researchers of the new study note that while about 50% of people with heart failure experience depression, only about half of them seek treatment.

Finding accessible, effective treatment for depression is crucial and can be lifesaving. Researchers believe behavioral activation therapy, the form of therapy used in the study, could be such a treatment.

“This empowers people to try out a treatment that is non-pharmacological, has less cardiac risk, and is just as effective,” first author Dr. Waguih Ishak, vice chair for Education and Research of Psychiatry and Behavioral Neuroscience at Cedars-Sinai in Los Angeles, told Healthline.

Over a 3-, 6-, and 12-month period, people who underwent behavioral activation saw just as much improvement in their depression symptoms as those taking antidepressants.

In both cases, subjects experienced a nearly 50% reduction in depression symptoms.

But those receiving therapy even slightly outperformed those who took medication in several key areas, including improved physical quality of life, fewer days hospitalized, and fewer emergency room visits.

The randomized trial, conducted by Cedars-Sinai in Los Angeles, recruited 416 patients with heart failure to receive treatment. Half of them were put on antidepressant medication, while the other half utilized behavioral activation therapy.

Behavioral activation therapy is an evidence-based therapy that uses activity to help treat depression. It has been the subject of numerous trials that have demonstrated its effectiveness.

A person has a conversation with a therapist, detailing activities that are meaningful to them, and then starts actively engaging in them. Activities could be as simple as:

  • getting out of the house for a walk
  • meeting with friends for social activities
  • volunteering

“When most people get depressed, they start to become less active. And the less active they get, they get more depressed. Behavioral activation is the exact opposite,” Ishak explained. “You basically load up your day on a regular basis with these activities that you enjoy doing.”

Dr. Randye J. Semple, an associate professor of clinical psychiatry and behavioral sciences at Keck School of Medicine at USC, who was unaffiliated with the new research, said the study results were unsurprising.

“The study is completely consistent with pretty much every other physical and mental health outcome comorbidity study with depression,” Semple told Healthline.

“If we can get the patients up and moving, doing things that increase their pleasure and mastery, then it will influence the depression.”

By demonstrating that behavioral activation therapy is just as effective at improving depression symptoms in heart failure patients, the study authors hope that it will also help to expand mental health access for this population.

According to Ishak, because so many people with heart failure are already taking numerous medications already, they may be “reluctant to seek treatment for fear of being told to take more.”

“The implication here is that not everybody has to get on antidepressants. That actually patients have a choice,” he said.

Antidepressants may also carry cardiovascular risk, causing symptoms such as:

“Someone with congestive heart failure may be vulnerable to dysregulation of cardiac activity,” said Dr. David Spiegel, associate Chair of Psychiatry and Behavioral Sciences at Stanford Medicine. “The nice thing about behavioral activation is that it’s not likely to complicate cardiac function.”

Spiegel, who wasn’t affiliated with the research but has worked with people with chronic conditions, including cancer and depression, told Healthline, “What we need is more therapies like that, that are easily disseminable, safe, and effective — and get more people using it.”

All the experts interviewed by Healthline agreed that improved access to behavioral activation therapy, such as increased telehealth options, especially for those with chronic illness, is a welcomed development.

Heart failure, which is when the heart muscle is unable to pump as much blood as the body needs, affects more than 6 million adults in the United States. In 2018, it was listed as a factor in nearly 400,000 deaths, according to the Centers for Disease Control and Prevention (CDC).

Heart failure affects an individual’s ability to socialize and engage in physical activities due to symptoms like:

  • shortness of breath
  • fatigue
  • irregular heartbeat

This negatively affects the overall quality of life and is part of the reason why mental health conditions like depression and anxiety are common in people with heart failure.

But illness-related mental health issues aren’t limited to just heart failure. Depression is commonly associated with many other chronic illnesses as well, such as cancer and diabetes.

The effectiveness of behavioral activation therapy for treating depression in people with heart failure could have the potential to expand access to other people with chronic conditions who would also benefit from it.

“It’s absolutely the case that this can work with the stresses associated with cancer as well as heart disease and other serious medical problems,” Spiegel said.

A form of psychotherapy known as behavioral activation therapy appears just as effective as antidepressant medication in treating depression symptoms in heart failure patients, according to a new study.

Depression is widespread among people with heart failure and other chronic illnesses and is likely underdiagnosed and undertreated.

Experts say that giving people living with chronic conditions more options and access to mental health treatment is essential.