Aerobic exercise (mean change -7.5) and sertraline (-6.1) achieved larger reductions in depressive symptoms compared to placebo (-4.5; p=0.034) in patients with coronary heart disease.
RCT (n=101)
randomized
Does aerobic exercise or sertraline reduce depressive symptoms in outpatients with coronary heart disease?
In patients with coronary heart disease and elevated depressive symptoms, both aerobic exercise and sertraline significantly reduced depressive symptoms compared to placebo.
Absolute Event Rate: -7.5% vs -4.5%
p-value: p=0.034
OBJECTIVE To assess the efficacy of exercise and antidepressant medication in reducing depressive symptoms and improving cardiovascular biomarkers in depressed patients with coronary heart disease (CHD). BACKGROUND Although there is good evidence that clinical depression is associated with poor prognosis, optimal therapeutic strategies are currently not well-defined. METHODS 101 outpatients with CHD and elevated depressive symptoms underwent assessment of depression including a psychiatric interview and the Hamilton Rating Scale for Depression (HAM-D). Participants were randomized to 4 months of aerobic exercise (3 times/week), sertraline (50-200 mg/day), or placebo. Additional assessments of cardiovascular biomarkers included measures of heart rate variability (HRV), endothelial function, baroreflex sensitivity, inflammation, and platelet function. RESULTS After 16 weeks, all groups showed improvement on HAM-D scores. Participants in both aerobic exercise (M= −7.5 95% CI = −9.8, −5.0) and sertraline (M= −6.1 95% CI = −8.4, −3.9 achieved larger reductions in depressive symptoms compared to placebo (M= −4.5 95% CI = −7.6, −1.5; p = .034); exercise and sertraline were equally effective in reducing depressive symptoms (p = .607). Exercise and medication tended to result in greater improvements in HRV compared to placebo (p = .052); exercise tended to result in greater improvements in HRV compared to sertraline (p =.093) CONCLUSIONS Both exercise and sertraline resulted in greater reductions in depressive symptoms compared to placebo in CHD patients. Evidence that active treatments may also improve cardiovascular biomarkers suggests that they may have a beneficial effect on clinical outcomes as well as quality of life.
“These results are the first from a randomized clinical trial to show that exercise reduces depressive symptoms in stable CHD, which is particularly important in light of the growing evidence that depression is associated with increased risk for fatal and nonfatal events in a wide range of CHD populations.”
Blumenthal et al. (2012) conducted an RCT in Coronary heart disease with elevated depressive symptoms (n=101). Aerobic exercise or sertraline vs. Placebo was evaluated on Change in Hamilton Rating Scale for Depression (HAM-D) score (p=0.034). Aerobic exercise (mean change -7.5) and sertraline (-6.1) achieved larger reductions in depressive symptoms compared to placebo (-4.5; p=0.034) in patients with coronary heart disease.