Beating the Blues for Your Heart

Depression is an independent risk factor for coronary artery disease (CAD); unfortunately, past trials have not detected a cardiovascular benefit. A promising and unexplored explanation for these results is that the interventions were delivered too late in the natural history of CAD. Because no study has evaluated this possibility, there is a critical need to determine whether evidence-based depression treatment, delivered before the onset of clinical CAD, reduces cardiovascular risk. Accordingly, the objective of the proposed clinical and translational research is to perform a preliminary evaluation of the efficacy of a highly disseminable depression intervention in decreasing CAD risk. To achieve this goal, a clinical trial of depressed primary care patients free of cardiovascular disease is being conducted. Patients will be randomized to usual care or a computer-based, cognitive behavioral intervention called Beating the Blues®, the most widely used and empirically supported computerized treatment program for depression. The primary outcome is brachial artery flow-mediated dilation, a noninvasive measure of endothelial function. The specific aim of the proposed trial is to evaluate whether Beating the Blues®, delivered prior to the onset of clinical CAD, improves endothelial dysfunction. Demonstrating that earlier treatment of depression with Beating the Blues lowers CAD risk, the long-term expected outcome, would place computed-based depression treatment in the armamentarium of CAD prevention strategies of the primary care provider. This change to clinical practice should result in improved cardiovascular risk management, which in turn would translate into reduced CAD morbidity and mortality.

Inclusion criteria

• Primary care patients
• Age ≥40 years
• Clinically significant depressive symptoms (Patient Health Questionnaire-9 ≥10)
• No history of cardiovascular disease

Exclusion criteria

• Pregnant women
• A history of chronic disorders (HIV/AIDS, chronic kidney disease, systemic inflammatory disease, or past-year cancer)
• Current use of anticoagulants or vasodilators (antihypertensive and lipid-lowering medications are allowed)
• Current drinking problem
• History of bipolar disorder or psychosis
• Ongoing treatment for depression with a psychiatrist or psychologist/ counselor (antidepressants alone are allowed)
• Severe cognitive impairment
• Acute risk of suicide
• Significant vision or hearing problems
• Individuals who do not read or speak English