Psychological and pharmacological interventions for depression in patients with coronary artery disease

Phillip J Tully; Ser Yee Ang; Emily JL Lee; Eileen Bendig; Natalie Bauereiß; Jürgen Bengel; Harald Baumeister

doi:10.1002/14651858.CD008012.pub4

Scolaris Content Display Scolaris Content Display

Contenido relacionado

Ir a:

Revisiones y protocolos relacionados
Respuestas clínicas Cochrane
Guías
Temas

Revisiones y protocolos relacionados

Respuestas clínicas Cochrane

Topics

Temas

Figure 1

Summary of the 2020 literature search update and study selection.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.1

Comparison 1: Psychological intervention versus control, Outcome 1: Depression symptoms ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.2

Comparison 1: Psychological intervention versus control, Outcome 2: Depression symptoms ‐ medium term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.3

Comparison 1: Psychological intervention versus control, Outcome 3: Depression symptoms ‐ long term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.4

Comparison 1: Psychological intervention versus control, Outcome 4: Depression remission ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.5

Comparison 1: Psychological intervention versus control, Outcome 5: Depression remission ‐ medium term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.6

Comparison 1: Psychological intervention versus control, Outcome 6: Depression remission ‐ long term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.7

Comparison 1: Psychological intervention versus control, Outcome 7: All‐cause mortality ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.8

Comparison 1: Psychological intervention versus control, Outcome 8: All‐cause mortality ‐ medium term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.9

Comparison 1: Psychological intervention versus control, Outcome 9: All‐cause mortality ‐ long term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.10

Comparison 1: Psychological intervention versus control, Outcome 10: Cardiovascular mortality ‐ medium term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.11

Comparison 1: Psychological intervention versus control, Outcome 11: Cardiovascular mortality ‐ long term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.12

Comparison 1: Psychological intervention versus control, Outcome 12: Myocardial infarction ‐ long term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.13

Comparison 1: Psychological intervention versus control, Outcome 13: Heart failure ‐ long term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.14

Comparison 1: Psychological intervention versus control, Outcome 14: Stroke ‐ long term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.15

Comparison 1: Psychological intervention versus control, Outcome 15: Coronary revascularisation procedure ‐ long term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.16

Comparison 1: Psychological intervention versus control, Outcome 16: Hospitalisations ‐ long term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.17

Comparison 1: Psychological intervention versus control, Outcome 17: Length of stay ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.18

Comparison 1: Psychological intervention versus control, Outcome 18: Quality of life SF‐12/36 physical ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.19

Comparison 1: Psychological intervention versus control, Outcome 19: Quality of life SF‐12/36 mental ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.20

Comparison 1: Psychological intervention versus control, Outcome 20: Quality of life SF‐12/36 physical ‐ medium term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.21

Comparison 1: Psychological intervention versus control, Outcome 21: Quality of life SF‐12/36 mental ‐ medium term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.22

Comparison 1: Psychological intervention versus control, Outcome 22: Quality of life SF‐12 total ‐ medium term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.23

Comparison 1: Psychological intervention versus control, Outcome 23: Quality of life SF‐36 physical ‐ long term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.24

Comparison 1: Psychological intervention versus control, Outcome 24: Quality of life SF‐36 mental ‐ long term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.1

Comparison 2: Psychological intervention versus psychological intervention/clinical management, Outcome 1: Depression symptoms ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.2

Comparison 2: Psychological intervention versus psychological intervention/clinical management, Outcome 2: Depression symptoms ‐ medium term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.3

Comparison 2: Psychological intervention versus psychological intervention/clinical management, Outcome 3: Depression symptoms ‐ long term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.4

Comparison 2: Psychological intervention versus psychological intervention/clinical management, Outcome 4: Depression remission ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.5

Comparison 2: Psychological intervention versus psychological intervention/clinical management, Outcome 5: Depression remission ‐ medium term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.6

Comparison 2: Psychological intervention versus psychological intervention/clinical management, Outcome 6: Depression remission ‐ long term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.7

Comparison 2: Psychological intervention versus psychological intervention/clinical management, Outcome 7: Cardiovascular mortality ‐ long term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.8

Comparison 2: Psychological intervention versus psychological intervention/clinical management, Outcome 8: Quality of life SF‐36 physical ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.9

Comparison 2: Psychological intervention versus psychological intervention/clinical management, Outcome 9: Quality of life SF‐36 mental ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.10

Comparison 2: Psychological intervention versus psychological intervention/clinical management, Outcome 10: Quality of life SF‐36 physical ‐ medium term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.11

Comparison 2: Psychological intervention versus psychological intervention/clinical management, Outcome 11: Quality of life SF‐36 mental ‐ medium term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.12

Comparison 2: Psychological intervention versus psychological intervention/clinical management, Outcome 12: Quality of life SF‐36 physical ‐ long term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.13

Comparison 2: Psychological intervention versus psychological intervention/clinical management, Outcome 13: Quality of life SF‐36 mental ‐ long term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.1

Comparison 3: Pharmacological intervention versus placebo, Outcome 1: Depression symptoms ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.2

Comparison 3: Pharmacological intervention versus placebo, Outcome 2: Depression symptoms change score ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.3

Comparison 3: Pharmacological intervention versus placebo, Outcome 3: Depression remission ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.4

Comparison 3: Pharmacological intervention versus placebo, Outcome 4: Depression response ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.5

Comparison 3: Pharmacological intervention versus placebo, Outcome 5: All‐cause mortality ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.6

Comparison 3: Pharmacological intervention versus placebo, Outcome 6: All‐cause mortality ‐ long term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.7

Comparison 3: Pharmacological intervention versus placebo, Outcome 7: Cardiovascular mortality ‐ long term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.8

Comparison 3: Pharmacological intervention versus placebo, Outcome 8: Myocardial infarction ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.9

Comparison 3: Pharmacological intervention versus placebo, Outcome 9: Myocardial infarction ‐ long term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.10

Comparison 3: Pharmacological intervention versus placebo, Outcome 10: Angina ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.11

Comparison 3: Pharmacological intervention versus placebo, Outcome 11: Heart failure ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.12

Comparison 3: Pharmacological intervention versus placebo, Outcome 12: Arrhythmia ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.13

Comparison 3: Pharmacological intervention versus placebo, Outcome 13: Stroke ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.14

Comparison 3: Pharmacological intervention versus placebo, Outcome 14: Coronary revascularisation procedure ‐ long term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.15

Comparison 3: Pharmacological intervention versus placebo, Outcome 15: Healthcare costs ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.16

Comparison 3: Pharmacological intervention versus placebo, Outcome 16: Hospitalisations ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.17

Comparison 3: Pharmacological intervention versus placebo, Outcome 17: Emergency department visits ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.18

Comparison 3: Pharmacological intervention versus placebo, Outcome 18: Quality of life Q‐LES‐Q ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.19

Comparison 3: Pharmacological intervention versus placebo, Outcome 19: Quality of life WHOQOL‐BREF Physical ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.20

Comparison 3: Pharmacological intervention versus placebo, Outcome 20: Quality of life WHOQOL‐BREF Psychological ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.21

Comparison 3: Pharmacological intervention versus placebo, Outcome 21: Quality of life WHOQOL‐BREF Social relationships ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.22

Comparison 3: Pharmacological intervention versus placebo, Outcome 22: Quality of life WHOQOL‐BREF Environmental ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.23

Comparison 3: Pharmacological intervention versus placebo, Outcome 23: Quality of life WHOQOL‐BREF Physical ‐ medium term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.24

Comparison 3: Pharmacological intervention versus placebo, Outcome 24: Quality of life WHOQOL‐BREF Psychological ‐ medium term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.25

Comparison 3: Pharmacological intervention versus placebo, Outcome 25: Quality of life WHOQOL‐BREF Social Relationships ‐ medium term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.26

Comparison 3: Pharmacological intervention versus placebo, Outcome 26: Quality of life WHOQOL‐BREF Environmental ‐ medium term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.27

Comparison 3: Pharmacological intervention versus placebo, Outcome 27: Systolic BP ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.28

Comparison 3: Pharmacological intervention versus placebo, Outcome 28: Diastolic BP ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.29

Comparison 3: Pharmacological intervention versus placebo, Outcome 29: Heart rate ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.30

Comparison 3: Pharmacological intervention versus placebo, Outcome 30: Platelet biomarker βTG ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.31

Comparison 3: Pharmacological intervention versus placebo, Outcome 31: Platelet biomarker PF4 ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.32

Comparison 3: Pharmacological intervention versus placebo, Outcome 32: Platelet biomarker P‐selectin ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.33

Comparison 3: Pharmacological intervention versus placebo, Outcome 33: Platelet biomarker PECAM‐1 ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 3: Pharmacological intervention versus placebo, Outcome 34: Platelet biomarker TxB 2 ‐ short term

Analysis 3.34

Comparison 3: Pharmacological intervention versus placebo, Outcome 34: Platelet biomarker TxB ₂ ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.35

Comparison 3: Pharmacological intervention versus placebo, Outcome 35: ECG PR interval ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.36

Comparison 3: Pharmacological intervention versus placebo, Outcome 36: ECG QRS interval ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.37

Comparison 3: Pharmacological intervention versus placebo, Outcome 37: ECG QT interval ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.38

Comparison 3: Pharmacological intervention versus placebo, Outcome 38: ECG QTc interval ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.39

Comparison 3: Pharmacological intervention versus placebo, Outcome 39: Non‐cardiac adverse events and side effects ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.1

Comparison 4: Pharmacological intervention versus pharmacological intervention, Outcome 1: Depression symptoms ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.2

Comparison 4: Pharmacological intervention versus pharmacological intervention, Outcome 2: Depression symptoms change score ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.3

Comparison 4: Pharmacological intervention versus pharmacological intervention, Outcome 3: Depression remission ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.4

Comparison 4: Pharmacological intervention versus pharmacological intervention, Outcome 4: Depression response ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.5

Comparison 4: Pharmacological intervention versus pharmacological intervention, Outcome 5: All‐cause mortality ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.6

Comparison 4: Pharmacological intervention versus pharmacological intervention, Outcome 6: Myocardial infarction ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.7

Comparison 4: Pharmacological intervention versus pharmacological intervention, Outcome 7: Angina ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.8

Comparison 4: Pharmacological intervention versus pharmacological intervention, Outcome 8: Heart failure ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.9

Comparison 4: Pharmacological intervention versus pharmacological intervention, Outcome 9: Arrhythmia ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.10

Comparison 4: Pharmacological intervention versus pharmacological intervention, Outcome 10: Coronary revascularisation procedure ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.11

Comparison 4: Pharmacological intervention versus pharmacological intervention, Outcome 11: Emergency department visits ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.12

Comparison 4: Pharmacological intervention versus pharmacological intervention, Outcome 12: Systolic BP ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.13

Comparison 4: Pharmacological intervention versus pharmacological intervention, Outcome 13: Diastolic BP ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.14

Comparison 4: Pharmacological intervention versus pharmacological intervention, Outcome 14: Heart rate ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.15

Comparison 4: Pharmacological intervention versus pharmacological intervention, Outcome 15: ECG PR interval ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.16

Comparison 4: Pharmacological intervention versus pharmacological intervention, Outcome 16: ECG QRS interval ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.17

Comparison 4: Pharmacological intervention versus pharmacological intervention, Outcome 17: ECG QTc interval ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.18

Comparison 4: Pharmacological intervention versus pharmacological intervention, Outcome 18: Non‐cardiac adverse events and side effects ‐ short term

Ir a la figura de la revisiónAbrir en una pestaña nueva

Summary of findings 1. Summary of findings table ‐ Psychological treatment compared to control for depression in patients with coronary artery disease

Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Psychological treatment compared to control for depression in patients with coronary artery disease
Patient or population: health problem or population Setting: cardiology in‐ and outpatient Intervention: Psychological treatment Comparison: Control
Outcomes	Risk with Control	Risk with Psychological treatment	Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Depression symptoms ‐ short‐term assessed with: objective and self‐reported measures of depression symptoms, higher scores indicate more severe symptoms	‐	SMD 0.55 SD lower (0.92 lower to 0.19 lower)	‐	1226 (10 RCTs)	⊕⊕⊝⊝ Low^a,^b	There is low certainty evidence that psychological treatment may result in a moderate reduction in depression symptoms at the end of treatment.
Depression remission ‐ short term assessed with: below cut‐points on objective and self‐report measures of depression	319 per 1000	486 per 1000 (267 to 708)	OR 2.02 (0.78 to 5.19)	862 (3 RCTs)	⊕⊕⊝⊝ Low^b,^c	There is low certainty evidence that psychological treatment may result in no difference in depression remission at the end of treatment.
All‐cause mortality ‐ short‐term assessed with: mortality records	25 per 1000	8 per 1000 (1 to 50)	OR 0.31 (0.05 to 2.02)	324 (2 RCTs)	⊕⊝⊝⊝ Very low^d,^e	The evidence is very uncertain about the effect of psychological treatment on all‐cause mortality at the end of treatment.
Cardiovascular mortality ‐ long‐term assessed with: cause of death according to standardised criteria on mortality records	85 per 1000	72 per 1000 (54 to 93)	OR 0.83 (0.62 to 1.10)	2720 (2 RCTs)	‐	No data for cardiovascular mortality at end of treatment in trials comparing psychological interventions versus usual care
Myocardial infarction ‐ short term (end of treatment) ‐ not reported	‐	‐	‐	‐	‐	No data for occurrence of myocardial infarction at end of treatment in trials comparing psychological interventions versus usual care
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; OR: odds ratio; SMD: standardised mean difference
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
See interactive version of this table: https://gdt.gradepro.org/presentations/#/isof/isof_question_revman_web_427596582080189491.
^a Risk of bias rated down one level ‐ trials that contributed to this outcome were rated as unclear risk of bias ^b Inconsistency rated down one level ‐ though confidence intervals generally overlapped, there was considerable unexplained statistical heterogeneity ^c Imprecision rated down one level ‐ confidence intervals encompass an adverse effect to beneficial effect ^d Risk of bias rated down two levels ‐ most trials that contributed to this outcome were rated as high or unclear risk of bias ^e Imprecision rated down two levels ‐ sparse events and wide confidence intervals encompass an adverse effect to beneficial effect

Summary of findings 1. Summary of findings table ‐ Psychological treatment compared to control for depression in patients with coronary artery disease

Ir a la tabla de la revisión

Summary of findings 2. Summary of findings table ‐ Psychological treatment 1 compared to psychological treatment 2 for depression in patients with coronary artery disease

Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Psychological treatment 1 compared to psychological treatment 2 for depression in patients with coronary artery disease
Patient or population: health problem or population Setting: cardiology outpatient settings Intervention: Psychological Treatment 1 Comparison: Psychological Treatment 2
Outcomes	Risk with Psychological Treatment 2	Risk with Psychological Treatment 1	Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Depression symptoms ‐ short term (end of treatment) assessed with: objective and self‐reported measures of depression symptoms; higher scores indicate more severe symptoms	Not pooled	Not pooled	Not pooled	219 (3 RCTs)	‐	No meta‐analysis performed due to clinical heterogeneity. The evidence is very uncertain as to whether different psychological interventions may result in a reduction in depression symptoms at the end of treatment for: cognitive‐behavioural therapy compared to supportive stress management (Freedland 2009); behaviour therapy compared to person‐centred therapy (Brown 1993); cognitive‐behavioural therapy and well‐being therapy compared to clinical management (TREATED‐ACS 2020).
Depression remission ‐ short term (end of treatment) assessed with: below cut‐off on Hamilton Rating Scale for Depression	571 per 1000	707 per 1000 (493 to 857)	OR 1.81 (0.73 to 4.50)	83 (1 RCT)	⊕⊕⊝⊝ Low^a	There is low certainty evidence from one trial that cognitive‐behavioural therapy may result in no difference in depression remission at the end of treatment compared to supportive stress management (Freedland 2009).
All‐cause mortality ‐ short term (end of treatment) ‐ not reported	‐	‐	‐	‐	‐	No data for all‐cause mortality at end of treatment in trials comparing psychological intervention versus another psychological intervention/clinical management
Cardiovascular mortality ‐ short term (end of treatment) ‐ not reported	‐	‐	‐	‐	‐	No data for cardiovascular mortality at end of treatment in trials comparing psychological intervention versus another psychological intervention/clinical management
Myocardial infarction ‐ short term (end of treatment) ‐ not reported	‐	‐	‐	‐	‐	No data for the occurrence of myocardial infarction at end of treatment in trials comparing psychological intervention versus another psychological intervention/clinical management
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; OR: odds ratio
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
See interactive version of this table: https://gdt.gradepro.org/presentations/#/isof/isof_question_revman_web_427665509108780589.
^a Imprecision rated down two levels ‐ wide confidence intervals from one trial encompass an adverse effect to beneficial effect

Summary of findings 2. Summary of findings table ‐ Psychological treatment 1 compared to psychological treatment 2 for depression in patients with coronary artery disease

Ir a la tabla de la revisión

Summary of findings 3. Summary of findings table ‐ Pharmacological treatment compared to placebo for depression in patients with coronary artery disease

Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Pharmacological treatment compared to placebo for depression in patients with coronary artery disease
Patient or population: health problem or population Setting: cardiology in‐ and outpatient settings Intervention: Pharmacological Comparison: Placebo
Outcomes	Risk with Placebo	Risk with Pharmacological	Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Depression symptoms ‐ short term assessed with: objective and self‐reported measures of depression; higher scores indicate more severe symptoms	‐	SMD 0.83 lower (1.33 lower to 0.32 lower)	‐	750 (8 RCTs)	⊕⊕⊝⊝ Low^a,^b	There is low certainty evidence that pharmacological intervention may result in a large reduction in depression symptoms at the end of treatment
Depression remission ‐ short term assessed with: below cut‐point on objective measure of depression (Hamilton Rating Scale for Depression)	323 per 1000	496 per 1000 (412 to 580)	OR 2.06 (1.47 to 2.89)	646 (4 RCTs)	⊕⊕⊕⊝ Moderate^a	There is moderate certainty evidence that pharmacological intervention probably results in a moderate to large increase in depression remission at the end of treatment.
All‐cause mortality ‐ short term assessed with: mortality records	36 per 1000	14 per 1000 (4 to 53)	OR 0.38 (0.10 to 1.47)	437 (2 RCTs)	⊕⊝⊝⊝ Very low^a,^c	The evidence is very uncertain about the effect of pharmacological intervention on all‐cause mortality at the end of treatment. In addition to the pooled results, data could not be extracted from 2 studies where no deaths occurred and from 1 trial which remained unclear.
Cardiovascular mortality ‐ short term (end of treatment) ‐ not reported	‐	‐	‐	‐	‐	No data for cardiovascular mortality at end of treatment in trials comparing pharmacological intervention versus placebo
Myocardial infarction ‐ short term assessed with: standardised criteria for fatal or non‐fatal myocardial infarction	22 per 1000	17 per 1000 (6 to 45)	OR 0.74 (0.26 to 2.09)	728 (3 RCTs)	⊕⊝⊝⊝ Very low^a,^c	The evidence is very uncertain about the effect of pharmacological intervention on myocardial infarction at the end of treatment.
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; OR: odds ratio; SMD: standardised mean difference
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
See interactive version of this table: https://gdt.gradepro.org/presentations/#/isof/isof_question_revman_web_427666962988765745.
^a Risk of bias rated down one level ‐ trials that contributed to this outcome were rated as unclear or high risk of bias ^b Inconsistency rated down one level ‐ though confidence intervals generally overlapped, there was considerable unexplained statistical heterogeneity ^c Imprecision rated down two levels ‐ sparse events and wide confidence intervals encompass an adverse effect to beneficial effect

Summary of findings 3. Summary of findings table ‐ Pharmacological treatment compared to placebo for depression in patients with coronary artery disease

Ir a la tabla de la revisión

Summary of findings 4. Summary of findings table ‐ Pharmacological treatment 1 compared to pharmacological treatment 2 for depression in patients with coronary artery disease

Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Pharmacological treatment 1 compared to pharmacological treatment 2 for depression in patients with coronary artery disease
Patient or population: health problem or population Setting: cardiology in‐ and outpatient settings Intervention: Pharmacological intervention 1 Comparison: Pharmacological intervention 2
Outcomes	Risk with Pharmacological intervention 2	Risk with Pharmacological intervention 1	Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Depression symptoms ‐ short term (end of treatment) assessed with: objective measure of depression (Hamilton Rating Scale for Depression); higher scores indicate more severe symptoms	Not pooled	Not pooled	Not pooled	442 (4 RCTs)	‐	No meta‐analysis performed due to clinical heterogeneity. The evidence is very uncertain as to whether different pharmacological interventions may result in a reduction in depression symptoms at the end of treatment for: simvastatin compared to atorvastatin (Abbasi 2015); sertraline plus omega‐3 compared to sertraline plus placebo (Carney 2009); paroxetine compared to fluoxetine (Tian 2016); escitalopram compared to Bu Xin Qi (Wang 2020).
Depression remission ‐ short term (end of treatment) assessed with: below cut‐points on objective and self‐report measures of depression	Not pooled	Not pooled	Not pooled	243 (3 RCTs)	‐	No meta‐analysis performed due to clinical heterogeneity. The evidence is very uncertain about the effect of pharmacological treatment compared to another pharmacological treatment on depression remission at the end of treatment .
All‐cause mortality ‐ short term (end of treatment) assessed with: mortality records	26 per 1000	68 per 1000 (14 to 281)	OR 2.72 (0.51 to 14.49)	149 (1 RCT)	⊕⊝⊝⊝ Very low^a,^b	The evidence from 1 trial is very uncertain about the effect of sertraline vs Shugan Jieyu on all‐cause mortality at the end of treatment (Liu 2016).
Cardiovascular mortality ‐ short term (end of treatment) ‐ not reported	‐	‐	‐	‐	‐	No data for cardiovascular mortality at end of treatment in trials comparing a pharmacological intervention versus another pharmacological intervention
Myocardial infarction ‐ short term (end of treatment) assessed with: standardised criteria for fatal and non‐fatal myocardial infarction	Not pooled	Not pooled	Not pooled	396 (3 RCTs)	‐	No meta‐analysis performed due to clinical heterogeneity. The evidence is very uncertain about the effect of pharmacological treatment compared to another pharmacological treatment on the occurrence of myocardial infarction at end of treatment for: sertraline plus omega‐3 compared to sertraline plus placebo (Carney 2009); paroxetine compared to fluoxetine (Tian 2016); escitalopram compared to Bu Xin Qi (Wang 2020).
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; OR: odds ratio
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
See interactive version of this table: https://gdt.gradepro.org/presentations/#/isof/isof_question_revman_web_428037497253281678.
^a Risk of bias rated down one level ‐ the trial(s) that contributed to this outcome were rated as unclear or high risk of bias ^b Imprecision rated down two levels ‐ sparse events and wide confidence intervals encompass an adverse effect to beneficial effect

Summary of findings 4. Summary of findings table ‐ Pharmacological treatment 1 compared to pharmacological treatment 2 for depression in patients with coronary artery disease

Ir a la tabla de la revisión

Table 1. Overview of study population

Study ID

Intervention

[n]screened

[n] randomised

[n] ITT

[n] finishing study

[%] of randomised participants
finishing study

Comments

Abbasi 2015

Intervention 1 (I1): simvastatin

Intervention 2 (I2): atorvastatin

Total: 206

I1: 29

I2: 29

Total: 58

I1: NR

I2: NR

Total: NR

(per‐protocol)

I1: 23

I2: 23

Total: 46

I1: 79.3%

I2: 79.3%

Total: 79.3%

ANDROS 2015

Intervention (I): sertraline

Control (C): placebo

Total: ?

I: ?

C: ?

Total: 2

I: ?

C: ?

Total: ?

I: ?

C: ?

Total: ?

I: ?

C: ?

Total: ?

Comment: trial terminated early, no results posted

Barth 2005

Intervention (I): resource‐orientated psychotherapy

Control (C): usual care

Total: 1709

I: 27

C: 32

Total: 59

I: 27

C: 32

Total: 59

(per‐protocol)

I: 27

C: 28

Total: 55

I: 100%

C: 87.5%

Total: 93.2%

Brown 1993

Intervention 1 (I1): behaviour therapy

Intervention 2 (I2): person‐centred therapy

Total: 107

I1: NR

I2: NR

Total: 54

I1: NR

I2: NR

Total: NR

(per‐protocol)

I1: 20

I2: 20

Total: 40

I1: ?

I2: ?

Total: 74.1%

Comment: dropout reported in text, no flow chart

CREATE 2007

Intervention 1 (I1): interpersonal psychotherapy, citalopram, clinical management

Intervention 2 (I2): citalopram, clinical management

Control 1 (C1): interpersonal psychotherapy, placebo, clinical management

Control 2 (C2): placebo, clinical management

Total: 1897

I1: 67

I2: 75

C1: 75

C2: 67

Total: 284

I1: 67

I2: 75

C1: 75

C2: 67

Total: 284

I1: 59

I2: 72

C1: 59

C2: 47

Total: 237

I1: 88.1%

I2: 96.0%

C1: 78.7%

C2: 70.1%

Total: 83.5%

Comment: 2 x 2 factorial trial; only I2 and C2 data are eligible for this review

Carney 2009

Intervention 1 (I1): sertraline plus omega‐3

Intervention 2 (I2): sertraline plus placebo

Total: 941

I1: 62

I2: 60

Total: 122

I1: 62

I2: 60

Total: 122

I1: 59

I2: 56

Total: 115

I1: 95.2%

I2: 93.3%

Total: 94.3%

Dao 2011

Intervention (I): cognitive‐ behavioural therapy

C: usual care

Total: 513

I: 50

C: 50

Total: 100

I: NR

C: NR

Total: NR

(per‐protocol)

I: 48

C: 48:

Total: 96

I: 96%

C: 96%

Total: 96%

Divsalar 2018

Intervention 1 (I1): sertraline plus red yeast rice

Intervention 2 (I2): sertraline plus placebo

Total: 101

I1: 28

I2: 28

Total: 56

I1: NR

I2: NR

Total: NR

I1: 25

I2: 25

Total: 50

I1: 89.3%

I2: 89.3%

Total: 89.3%

Doering 2007

Intervention (I): cognitive‐ behavioural therapy

Control (C): usual care

Total: 117

I: NR

C: NR

Total: NR

I: NR

C: NR

Total: NR

(per‐protocol)

I: 7

C: 8

Total: 15

I: ?

C: ?

Total: ?

Comment: reasons for dropout not stated, no flow chart

Comment: nested trial within observational study (non‐depressed cohort)

EsDEPACS 2014

Intervention (I): escitalopram

Control (C): placebo

Total: 4809

I:149

C: 151

Total: 300

I: 108

C: 109

Total: 217 (per‐protocol)

I: 78

C: 79

Total: 157

I: 52.3%

C: 52.3%

Total: 52.3%

Comment: nested trial within observational study (depressed cohort receiving usual care)

ENRICHD 2003

Intervention (I): cognitive‐ behavioural therapy

Control (C): usual care

Total: 33780

I: 1238

C: 1243

Total: 2481

I: 1238

C: 1243

Total: 2481

I: 983

C: 985

Total: 1968

I: 79.4%

C: 79.2%

Total: 79.3%

Fang 2003

Intervention (I): health education and psychological intervention

Control (C): usual care

Total: ?

I: 27

C: 30

Total: 57

I: ?

C: ?

Total: ?

I: ?

C: ?

Total: ?

I: ?

C: ?

Total: ?

Comment: translated paper

Freedland 2009

Intervention 1 (I1): cognitive‐ behavioural therapy

Intervention 2 (I2): supportive stress management

Control (C): usual care

Total: 2955

I1: 41

I2: 42

C1: 40

Total: 123

I1: 41

I2: 42

C1: 40

Total: 123

I1: 40

I2: 33

C1: ?

Total: ?

I1: 98%

I2: 79%

C1: ?

Total: ?

Freeman 1986

Intervention (I): alprazolam

Control (C): placebo

Total: 459

I: 54

C: 53

Total: 107

I: NR

C: NR

Total: NR (per‐protocol)

I: 32

C: 28

Total: 60

I: 59.3%

C: 52.8%

Total: 56.1%

Comment: no flow chart

Kennedy 2005

Intervention (I): escitalopram

Control (C): placebo

Total: NR

I: 9

C: 10

Total: 19

I: NR

C: NR

Total: NR

(per‐protocol)

I: 2

C: 2

Total: 4

I: 22.2%

C: 20.0%

Total: 21.1%

Comment: trial terminated early, redacted results posted

Li 2005

Intervention (I): St John's wort extract

Control (C): placebo

Total: ?

I: ?

C: ?

Total: 87

I: ?

C: ?

Total: ?

I: 43

C: 39

Total: 82

I: ?

C: ?

Total: 94.3%

Comment: translated paper

Liu 1999

Intervention (I): fluoxetine

Control (C): placebo

Total: ?

I: ?

C: ?

Total: ?

I: ?

C: ?

Total: ?

I: 31

C: 37

Total: ?

I: ?

C: ?

Total: ?

Comment: translated paper

Liu 2016

Intervention 1 (I1): sertraline and Shugan Jieyu

Intervention 2 (I2): sertraline and placebo

Total: 3907

I1: 76

I2: 73

Total: 149

I1: 76

I2: 73

Total: 149

I1: 48

I2: 46

Total: 94

I1: 63.2%

I2: 63.0%

Total: 63.1%

Comment: no flow chart, reasons for dropout reported in text

MIND‐IT 2007

Intervention (I): mirtazapine

Control (C): placebo

Total: 2177

I: 47

C: 44

Total: 91

I: 47

C: 44

Total: 91

I: 22

C: 18

Total: 40

I: 46.8%

C: 40.9%

Total: 44.0%

Comment: nested trial within observational study (depressed cohort receiving usual care)

Ma 2019

Intervention (I): Xinkeshu

Control (C): placebo

Total: 312

I: 30

C: 30

Total: 60

I: NR

C: NR

Total: NR

I: 28

C: 27

Total: 55

I: 93.3%

C: 90%

Total: 91.7%

McFarlane 2001

Intervention (I): sertraline

Control (C): placebo

Total: 238

I: 18

C: 20

Total: 38

I: NR

C: NR

Total: NR (per‐protocol)

I: 12

C: 15

Total: 27

I: 66.7%

C: 75.0%

Total: 71.1%

Comment: no flow chart, reasons for dropout reported in text

McLaughlin 2005

Intervention (I1): telephone counselling

Control (C): usual care

Total: 700

I: 53

C: 47

Total: 100

I: NR

C: NR

Total: NR (per‐protocol)

I: 45

C: 34

Total: 79

I: 84.9%

C: 72.3%

Total: 79%

MoodCare 2011

Intervention (I): cognitive‐ behavioural therapy
Control (C): usual care

Total: 3071

I: 61

C: 60

Total: 121

I: NR

C: NR

Total: NR

I: 53

C: 53

Total: 106

I: 86.9%

C: 88.3%

Total: 87.6%

Pizzi 2009

Intervention (I): sertraline

Control (C): placebo

Total: 630

I: 50

C: 50

Total: 100

I: NR

C: NR

Total: NR (per‐protocol)

I: 47

C: 48

Total: 95

I: 94%

C: 96%

Total: 95%

Roose 1998

Intervention 1 (I1): paroxetine

Intervention 2 (I2): nortriptyline

Total: NR

I1: 41

I2: 40

Total: 81

I1: 41

I2: 40

Total: 81

I1: 37

I2: 30

Total: 67

I1: 90.2%

I2: 75.0%

Total: 82.7%

Comment: no flow chart, reasons for dropout reported in text

SADHART 2002

Intervention (I): sertraline

Control (C): placebo

Total: 11546

I: 186

C: 183

Total: 369

I: 186

C: 183

Total: 169

I: 133

C: 137

Total: 270

I: 71.5%

C: 74.9%

Total: 73.1%

SPIRR‐CAD 2011

Intervention (I): stepwise psychotherapy intervention

Control (C): usual care

Total: 21780

I: 285

C: 285

Total: 570

I: 284

C: 284

Total: 568

I: 110

C: 194

Total: 304

I: 38.6%

C: 68.1%

Total: 53.3%

Shahmansouri 2014

Intervention 1 (I1): fluoxetine

Intervention 2 (I2): Crocus sativus L. (saffron)

Total: 75

I1: 22

I2: 22

Total: 44

I1: NR

I2: NR

Total: NR (per‐protocol)

I1: 20

I2: 20

Total: 40

I1: 90.9%

I2: 90.9%

Total: 90.9%

Strik 2000

Intervention (I): fluoxetine

Control (C): placebo

Total: 556

I: 27

C: 27

Total: 54

I: 27

C: 27

Total: 54

I: 22

C: 18

Total: 40

I: 81.5%

C: 66.7%

Total: 74.1%

Tian 2016

Intervention 1 (I1): paroxetine

Intervention 2 (I2): fluoxetine

Total: ?

I1: 23

I2: 23

Total: 46

I1: 23

I2: 23

Total: 46 (per‐protocol)

I1: 23

I2: 23

Total: 46

I1: 100%

I2: 100%

Total: 100%

Comment: no flow chart was reported. It is unclear whether 16 participants who did not finish the study were from I1 or I2 groups, or non‐treatment or non‐depressed groups.

TREATED‐ACS 2020

Intervention 1 (I1): cognitive‐behavioural therapy and well‐being therapy

Intervention 2 (I2): clinical management

Total: 740

I1: 50

I2: 50

Total: 100

I1: 50

I2: 50

Total: 100

I1: 42

I2: 40

Total: 82

I1: 84%

I2: 80%

Total: 82%

U‐CARE 2018

Intervention (I): internet cognitive‐behavioural therapy

Control (C): usual care

Total: 3928

I: 117

C: 122

Total: 239

I: 117

C: 122

Total: 239

I: 96

C: 115

Total: 211

I: 82.1%

C: 94.3%

Total: 88.3%

UPBEAT 2012

Intervention 1 (I1): sertraline

Intervention 2 (I2): exercise

Control (C): placebo

Total: 1680

I1: 40

I2: 37

C: 24

Total: 101

I1: NR

I2: NR

C: NR

Total: NR

I1: 36

I2: 36

C: 23

Total: 95

I1: 90%

I2: 97.3%

C: 95.8%

Total: 94.1%

Comment: only I1 sertraline and C placebo are eligible for this review

Wang 2020

Intervention 1 (I1): escitalopram

Intervention 2 (I2):

Bu Xin Qi decoction

Total: 300

I1: 140

I2: 140

Total: 280

I1: NR

I2: NR

Total: NR (per‐protocol)

I1: 113

I2: 115

Total: 228

I1: 80.7%

I2: 82.1%

Total: 81.4%

Comment: reasons for dropout not stated in flow chart

WIDeCAD 2017

Intervention (I): internet cognitive‐behavioural therapy

Control (C): wait‐list control

Total: 72

I: 18

C: 16

Total: 34

I: 18

C: 16

Total: 34

I: 13

C: 13

Total: 26

I: 72.2%

C: 81.3%

Total: 76.5%

Yang 2019

Intervention (I): intensive telephone‐based care

Control (C): usual care

Total: 354

I: 112

C: 112

Total: 224

I: NR

C: NR

Total: NR

I: 107

C: 105

Total: 212

I: 95.5%

C: 93.8%

Total: 94.6%

Zarea 2014

Intervention (I): Peplau's therapeutic communication model

Control (C): usual care

Total: ?

I: ?

C: ?

Total: ?

I: ?

C: ?

Total: ? (per‐protocol)

I: 37

C: 37

Total: 74

I: ?

C: ?

Total: ?

Comment: total sample estimated from degrees of freedom in Table 3

ITT = intention‐to‐treat; NR = not reported; ? = unclear

Table 1. Overview of study population

Ir a la tabla de la revisión

Table 2. Sensitivity analyses for depression symptoms at end of treatment in psychological versus control trials

Comparison	Sensitivity analysis	Study references [n]	SMD	I²
Psychological vs control	None (Analysis 1.1)	Barth 2005; Dao 2011; Fang 2003; Freedland 2009; McLaughlin 2005; MoodCare 2011; SPIRR‐CAD 2011; U‐CARE 2018; WIDeCAD 2017; Zarea 2014 (n = 1226)	−0.55 (95% CI −0.92 to −0.19)	88
Psychological vs control	Constrained to trials without depression disorders as part of the inclusion criteria	Barth 2005; Dao 2011; Fang 2003; McLaughlin 2005; MoodCare 2011; SPIRR‐CAD 2011; U‐CARE 2018; WIDeCAD 2017; Zarea 2014 (n = 1145)	−0.53 (95% CI −0.92 to −0.13)	89
Psychological vs control	Constrained to depression (e.g. excluding trials with mixed depression and/or anxiety as part of the inclusion criteria)	Barth 2005; Freedland 2009; MoodCare 2011; SPIRR‐CAD 2011; WIDeCAD 2017 (n = 681)	−0.27 (95% CI −0.58 to 0.03)	65
Psychological vs control	Constrained to cognitive‐behavioural therapy trials	Dao 2011; Freedland 2009; MoodCare 2011; U‐CARE 2018; WIDeCAD 2017 (n = 571)	−0.48 (95% CI −0.77 to −0.19)	61
CI = confidence interval; SMD = standardised mean difference

Table 2. Sensitivity analyses for depression symptoms at end of treatment in psychological versus control trials

Ir a la tabla de la revisión

Table 3. Sensitivity analyses for depression symptoms at end of treatment in pharmacological versus placebo trials

Comparison	Sensitivity analysis	Study references [n]	SMD	I²
Pharmacological vs placebo	None (Analysis 3.1)	CREATE 2007; EsDEPACS 2014; Li 2005; Liu 1999; Ma 2019; McFarlane 2001; Pizzi 2009; UPBEAT 2012 (n = 750)	SMD −0.83 (95% CI −1.33 to −0.32)	90
Pharmacological vs placebo	Constrained to trials with major depressive disorders as part of the inclusion criteria	CREATE 2007; EsDEPACS 2014; Liu 1999 (n = 427)	SMD −0.48 (95% CI −1.38 to 0.42)	95
Pharmacological vs placebo	Constrained to depression (e.g. excluding trials with mixed depression and/or anxiety as part of the inclusion criteria)	CREATE 2007; EsDEPACS 2014; Li 2005; Liu 1999; McFarlane 2001; Pizzi 2009; UPBEAT 2012 (n = 695)	SMD −0.76 (95% CI −1.29 to −0.23)	90
Pharmacological vs placebo	Constrained to serotonergic antidepressant trials	CREATE 2007; EsDEPACS 2014; Liu 1999; McFarlane 2001; Pizzi 2009; UPBEAT 2012 (n = 613)	SMD −0.69 (95% CI −1.27 to −0.11)	91
CI = confidence interval; SMD = standardised mean difference

Table 3. Sensitivity analyses for depression symptoms at end of treatment in pharmacological versus placebo trials

Ir a la tabla de la revisión

Comparison 1. Psychological intervention versus control

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1.1 Depression symptoms ‐ short term Show forest plot	10	1226	Std. Mean Difference (IV, Random, 95% CI)	‐0.55 [‐0.92, ‐0.19]

1.2 Depression symptoms ‐ medium term Show forest plot	7	2620	Std. Mean Difference (IV, Random, 95% CI)	‐0.20 [‐0.42, 0.01]

1.3 Depression symptoms ‐ long term Show forest plot	2	282	Std. Mean Difference (IV, Random, 95% CI)	‐0.46 [‐0.96, 0.04]

1.4 Depression remission ‐ short term Show forest plot	3	862	Odds Ratio (IV, Random, 95% CI)	2.02 [0.78, 5.19]

1.5 Depression remission ‐ medium term Show forest plot	1		Odds Ratio (IV, Random, 95% CI)	Totals not selected

1.6 Depression remission ‐ long term Show forest plot	1		Odds Ratio (IV, Random, 95% CI)	Totals not selected

1.7 All‐cause mortality ‐ short term Show forest plot	2	324	Odds Ratio (IV, Random, 95% CI)	0.31 [0.05, 2.02]

1.8 All‐cause mortality ‐ medium term Show forest plot	1		Odds Ratio (IV, Random, 95% CI)	Totals not selected

1.9 All‐cause mortality ‐ long term Show forest plot	2	2670	Odds Ratio (IV, Random, 95% CI)	0.83 [0.48, 1.42]

1.10 Cardiovascular mortality ‐ medium term Show forest plot	1		Odds Ratio (IV, Random, 95% CI)	Totals not selected

1.11 Cardiovascular mortality ‐ long term Show forest plot	2	2720	Odds Ratio (IV, Random, 95% CI)	0.83 [0.62, 1.10]

1.12 Myocardial infarction ‐ long term Show forest plot	2	2720	Odds Ratio (IV, Random, 95% CI)	1.09 [0.73, 1.65]

1.13 Heart failure ‐ long term Show forest plot	1		Odds Ratio (IV, Random, 95% CI)	Totals not selected

1.14 Stroke ‐ long term Show forest plot	1		Odds Ratio (IV, Random, 95% CI)	Totals not selected

1.15 Coronary revascularisation procedure ‐ long term Show forest plot	2	2780	Odds Ratio (IV, Random, 95% CI)	0.91 [0.75, 1.11]

1.16 Hospitalisations ‐ long term Show forest plot	1		Odds Ratio (IV, Random, 95% CI)	Totals not selected

1.17 Length of stay ‐ short term Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

1.18 Quality of life SF‐12/36 physical ‐ short term Show forest plot	2	202	Std. Mean Difference (IV, Random, 95% CI)	0.22 [‐0.06, 0.50]

1.19 Quality of life SF‐12/36 mental ‐ short term Show forest plot	2	202	Std. Mean Difference (IV, Random, 95% CI)	0.51 [0.07, 0.94]

1.20 Quality of life SF‐12/36 physical ‐ medium term Show forest plot	2	187	Std. Mean Difference (IV, Random, 95% CI)	0.18 [‐1.29, 1.65]

1.21 Quality of life SF‐12/36 mental ‐ medium term Show forest plot	2	187	Std. Mean Difference (IV, Random, 95% CI)	1.21 [‐1.09, 3.52]

1.22 Quality of life SF‐12 total ‐ medium term Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

1.23 Quality of life SF‐36 physical ‐ long term Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

1.24 Quality of life SF‐36 mental ‐ long term Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

Comparison 1. Psychological intervention versus control

Ir a la tabla de la revisión

Comparison 2. Psychological intervention versus psychological intervention/clinical management

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2.1 Depression symptoms ‐ short term Show forest plot	3		Mean Difference (IV, Random, 95% CI)	Totals not selected

2.2 Depression symptoms ‐ medium term Show forest plot	3		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

2.3 Depression symptoms ‐ long term Show forest plot	3		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

2.4 Depression remission ‐ short term Show forest plot	1		Odds Ratio (IV, Random, 95% CI)	Totals not selected

2.5 Depression remission ‐ medium term Show forest plot	1		Odds Ratio (IV, Random, 95% CI)	Totals not selected

2.6 Depression remission ‐ long term Show forest plot	1		Odds Ratio (IV, Random, 95% CI)	Totals not selected

2.7 Cardiovascular mortality ‐ long term Show forest plot	1		Odds Ratio (IV, Random, 95% CI)	Totals not selected

2.8 Quality of life SF‐36 physical ‐ short term Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

2.9 Quality of life SF‐36 mental ‐ short term Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

2.10 Quality of life SF‐36 physical ‐ medium term Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

2.11 Quality of life SF‐36 mental ‐ medium term Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

2.12 Quality of life SF‐36 physical ‐ long term Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

2.13 Quality of life SF‐36 mental ‐ long term Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

Comparison 2. Psychological intervention versus psychological intervention/clinical management

Ir a la tabla de la revisión

Comparison 3. Pharmacological intervention versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
3.1 Depression symptoms ‐ short term Show forest plot	8	750	Std. Mean Difference (IV, Random, 95% CI)	‐0.83 [‐1.33, ‐0.32]

3.2 Depression symptoms change score ‐ short term Show forest plot	3	482	Std. Mean Difference (IV, Random, 95% CI)	‐0.18 [‐0.36, ‐0.00]

3.3 Depression remission ‐ short term Show forest plot	4	646	Odds Ratio (IV, Random, 95% CI)	2.06 [1.47, 2.89]

3.4 Depression response ‐ short term Show forest plot	5	891	Odds Ratio (IV, Random, 95% CI)	2.73 [1.65, 4.54]

3.5 All‐cause mortality ‐ short term Show forest plot	2	437	Odds Ratio (IV, Random, 95% CI)	0.38 [0.10, 1.47]

3.6 All‐cause mortality ‐ long term Show forest plot	2	661	Odds Ratio (IV, Random, 95% CI)	0.89 [0.64, 1.25]

3.7 Cardiovascular mortality ‐ long term Show forest plot	1		Odds Ratio (IV, Random, 95% CI)	Totals not selected

3.8 Myocardial infarction ‐ short term Show forest plot	3	728	Odds Ratio (IV, Random, 95% CI)	0.74 [0.26, 2.09]

3.9 Myocardial infarction ‐ long term Show forest plot	1		Odds Ratio (IV, Random, 95% CI)	Subtotals only

3.10 Angina ‐ short term Show forest plot	4	819	Odds Ratio (IV, Random, 95% CI)	0.75 [0.44, 1.28]

3.11 Heart failure ‐ short term Show forest plot	3	602	Odds Ratio (IV, Random, 95% CI)	0.93 [0.33, 2.62]

3.12 Arrhythmia ‐ short term Show forest plot	2	87	Odds Ratio (IV, Random, 95% CI)	0.46 [0.01, 17.06]

3.13 Stroke ‐ short term Show forest plot	2	586	Odds Ratio (IV, Random, 95% CI)	0.99 [0.20, 4.96]

3.14 Coronary revascularisation procedure ‐ long term Show forest plot	1	300	Odds Ratio (IV, Random, 95% CI)	0.59 [0.32, 1.10]

3.15 Healthcare costs ‐ short term Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

3.16 Hospitalisations ‐ short term Show forest plot	3	514	Odds Ratio (M‐H, Random, 95% CI)	0.58 [0.39, 0.85]

3.17 Emergency department visits ‐ short term Show forest plot	1		Odds Ratio (M‐H, Random, 95% CI)	Subtotals only

3.18 Quality of life Q‐LES‐Q ‐ short term Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

3.19 Quality of life WHOQOL‐BREF Physical ‐ short term Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

3.20 Quality of life WHOQOL‐BREF Psychological ‐ short term Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

3.21 Quality of life WHOQOL‐BREF Social relationships ‐ short term Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

3.22 Quality of life WHOQOL‐BREF Environmental ‐ short term Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

3.23 Quality of life WHOQOL‐BREF Physical ‐ medium term Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

3.24 Quality of life WHOQOL‐BREF Psychological ‐ medium term Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

3.25 Quality of life WHOQOL‐BREF Social Relationships ‐ medium term Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

3.26 Quality of life WHOQOL‐BREF Environmental ‐ medium term Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

3.27 Systolic BP ‐ short term Show forest plot	3	675	Mean Difference (IV, Random, 95% CI)	‐0.24 [‐3.52, 3.05]

3.28 Diastolic BP ‐ short term Show forest plot	3	675	Mean Difference (IV, Random, 95% CI)	0.60 [‐1.55, 2.74]

3.29 Heart rate ‐ short term Show forest plot	4	662	Mean Difference (IV, Random, 95% CI)	‐0.80 [‐2.40, 0.79]

3.30 Platelet biomarker βTG ‐ short term Show forest plot	3	141	Std. Mean Difference (IV, Random, 95% CI)	‐0.54 [‐0.99, ‐0.09]

3.31 Platelet biomarker PF4 ‐ short term Show forest plot	3	144	Std. Mean Difference (IV, Random, 95% CI)	‐0.14 [‐0.48, 0.19]

3.32 Platelet biomarker P‐selectin ‐ short term Show forest plot	2	121	Std. Mean Difference (IV, Random, 95% CI)	‐0.31 [‐1.12, 0.50]

3.33 Platelet biomarker PECAM‐1 ‐ short term Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Subtotals only

3.34 Platelet biomarker TxB ₂ ‐ short term Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Subtotals only

3.35 ECG PR interval ‐ short term Show forest plot	3	635	Mean Difference (IV, Random, 95% CI)	‐4.35 [‐8.40, ‐0.31]

3.36 ECG QRS interval ‐ short term Show forest plot	3	635	Mean Difference (IV, Random, 95% CI)	2.37 [‐0.41, 5.15]

3.37 ECG QT interval ‐ short term Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Subtotals only

3.38 ECG QTc interval ‐ short term Show forest plot	3	635	Mean Difference (IV, Random, 95% CI)	2.76 [‐1.96, 7.47]

3.39 Non‐cardiac adverse events and side effects ‐ short term Show forest plot	8	1193	Odds Ratio (M‐H, Random, 95% CI)	1.44 [1.07, 1.92]

Comparison 3. Pharmacological intervention versus placebo

Ir a la tabla de la revisión

Comparison 4. Pharmacological intervention versus pharmacological intervention

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
4.1 Depression symptoms ‐ short term Show forest plot	4		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

4.2 Depression symptoms change score ‐ short term Show forest plot	4		Std. Mean Difference (IV, Random, 95% CI)	Totals not selected

4.3 Depression remission ‐ short term Show forest plot	3		Odds Ratio (IV, Random, 95% CI)	Totals not selected

4.4 Depression response ‐ short term Show forest plot	4		Odds Ratio (IV, Random, 95% CI)	Totals not selected

4.5 All‐cause mortality ‐ short term Show forest plot	1		Odds Ratio (M‐H, Random, 95% CI)	Totals not selected

4.6 Myocardial infarction ‐ short term Show forest plot	3		Odds Ratio (M‐H, Random, 95% CI)	Totals not selected

4.7 Angina ‐ short term Show forest plot	3		Odds Ratio (M‐H, Random, 95% CI)	Totals not selected

4.8 Heart failure ‐ short term Show forest plot	2		Odds Ratio (M‐H, Random, 95% CI)	Totals not selected

4.9 Arrhythmia ‐ short term Show forest plot	3		Odds Ratio (M‐H, Random, 95% CI)	Totals not selected

4.10 Coronary revascularisation procedure ‐ short term Show forest plot	1		Odds Ratio (M‐H, Random, 95% CI)	Totals not selected

4.11 Emergency department visits ‐ short term Show forest plot	1		Odds Ratio (M‐H, Random, 95% CI)	Totals not selected

4.12 Systolic BP ‐ short term Show forest plot	3		Mean Difference (IV, Random, 95% CI)	Totals not selected

4.13 Diastolic BP ‐ short term Show forest plot	3		Mean Difference (IV, Random, 95% CI)	Totals not selected

4.14 Heart rate ‐ short term Show forest plot	2		Mean Difference (IV, Random, 95% CI)	Totals not selected

4.15 ECG PR interval ‐ short term Show forest plot	2		Mean Difference (IV, Random, 95% CI)	Totals not selected

4.16 ECG QRS interval ‐ short term Show forest plot	2		Mean Difference (IV, Random, 95% CI)	Totals not selected

4.17 ECG QTc interval ‐ short term Show forest plot	2		Mean Difference (IV, Random, 95% CI)	Totals not selected

4.18 Non‐cardiac adverse events and side effects ‐ short term Show forest plot	7		Odds Ratio (M‐H, Random, 95% CI)	Totals not selected

Comparison 4. Pharmacological intervention versus pharmacological intervention

Ir a la tabla de la revisión

The Cochrane Library

Scolaris Language Selector Scolaris Language Selector

Idioma de la Revisión Cochrane

Idioma de la web

Scolaris Content Language Banner Portlet Scolaris Content Language Banner Portlet

Scolaris Content Display Scolaris Content Display

Temas

Scolaris Language Selector Scolaris Language Selector

Scolaris Content Display Scolaris Content Display

Instituciones a las que se accedió previamente

Scolaris Content Display Scolaris Content Display

Usuarios institucionales

Instituciones a las que se accedió previamente

Otras opciones de acceso

	Idioma de la Revisión Cochrane Escoja su idioma de preferencia para las revisiones Cochrane y otros contenidos. Las secciones sin una traducción aparecerán en inglés.

	Idioma de la web Escoja su idioma de preferencia para la web de la Biblioteca Cochrane.

Idioma de la Revisión Cochrane

Idioma de la web

Contenido relacionado

Revisiones y protocolos relacionados

Respuestas clínicas Cochrane

Temas

Copiar o descargar referencia

Idioma de la Revisión Cochrane

Idioma de la web

Instituciones a las que se accedió previamente

Usuarios institucionales

Instituciones a las que se accedió previamente

Otras opciones de acceso