Psychological Treatment Of Coronary Heart Disease Rehabilitation

OBJECTIVE: Depression is a common problem in patients with coronary heart disease (CHD) and is associated with an increased risk for cardiac morbidity and mortality. It is not known whether treating depression will improve medical prognosis in patients with CHD. Safe, effective treatments for depression are psychotherapies, but unless they also improve the underlying pathophysiological or behavioral mechanisms that contribute to cardiac morbidity and mortality, they may not have beneficial effects on prognosis. Platelets play an important role not only in hemostasis but also in the pathophysiology of coronary artery disease. The complex interactions among the vascular endothelium, platelets, and blood components are one of the most exciting research areas today. Results of current studies suggest that platelets are affected by diverse stressors, including psychological ones; Depression is also associated with elevated changes of factors in platelet(MPV and PDW), which are known risk factors for cardiac morbidity and mortality that may explain the increased risk associated with depression. The purpose of this study was to determine whether treatment for depression with Rational emotional behavior therapy(REBT) and transcendental meditation(TM) are associated with decreased MPV and PDW. METHODS: Seventy depressed patients with stable CHD were allot into case-group and control-group randomly, each group contained 35 patients. Demographic and selected medical variables of the patients in two groups are compared, There were no significant differences among the two groups on any of these variables .The case group were given not only conventional medical treatment but also the comprehensive psychotherapy such as REBT, TM for sixteen weeks. The following clinical indexes were examined and compared between two groups before treatment and after treatment; MPV, PDW, ECG, angina pectoris grades. The Beck Depression Inventory (BDI) and perceived social support scale (PSSS) were tested and compared between the two concurrent groups before treatment and after treatment RESULTS: MPV, PDW(reflecting mostly platelet activity), BDI decreased significantly inthe depressed patients in case group(p<0.001), but remained unchanged in the control patients. ST depression , angina pectoris grades improved in both groups, but case group improved significantly compared with control group. Decreased MPV, PDW were releated with decreased BDI, and improved ST depression were releated with decreased BDI, PSSS. CONCLUSIONS: The results suggest that treating depression with REBT and TM may reduce MPV, PDW 3DI and improve ST depression. Thus, REBT and TM may have a beneficial effect on a risk factor for mortality in depressed patients with coronary heart disease. But a long-term followed review of these patients is needed to confirm these findings.