Psychotherapy Matches Medication in Treating Depression in Heart Failure

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For the over 6 million Americans suffering from heart failure, depression is an all too common burden - one doctors usually treat with medication notorious for their serious side effects. But what if there was an equally effective treatment that didn't involve more pills? A groundbreaking new study provides the most compelling evidence yet for a drug-free alternative.

Coping with heart failure is a challenge for both mind and body. Depression affects around half of the over 6 million Americans diagnosed with this condition, exacerbating their physical symptoms and quality of life.1 The standard treatment is antidepressant medication in the SSRI category, but many patients are reluctant to add yet more pills to their already intensive drug regimens. What if psychotherapy alone could be just as effective?

A landmark new study provides the strongest evidence yet that a non-drug treatment may help as much as medication. The research, published in the journal JAMA Network Open, is the largest trial to date to directly compare psychotherapy and antidepressants head-to-head in heart failure patients suffering from depression.2

The researchers enrolled 416 patients who were diagnosed with both heart failure and clinical depression. Half were randomly assigned to receive an evidence-based type of psychotherapy called "behavioral activation." This approach helps patients engage in positive activities tailored to their personal values and abilities. The other half received standard treatment with antidepressant medication managed by their regular doctors.

After 6 months, depressive symptoms dropped by around 50% in both groups, with no significant difference between the two approaches. Interestingly, the psychotherapy patients experienced a small but meaningful improvement in physical quality of life compared to those on medication. They also visited the emergency room less often and spent fewer days admitted in the hospital over the year-long study.

According to lead study author Dr. Waguih William IsHak, a professor of psychiatry at Cedars-Sinai Medical Center in Los Angeles, this shows patients can be empowered to choose their preferred treatment approach. "Our findings demonstrate that both interventions are comparably effective in reducing depression for patients with heart failure, giving patients, caregivers and health care practitioners the choice between behavioral activation and medication," he said.2

The study used a pragmatic design to mimic real-world conditions as much as possible. Researchers recruited a diverse group of patients from both inpatient and outpatient settings. Therapy and medication management were administered via video or phone, as would often be the case in routine medical practice, especially during the declared COVID-19 pandemic. This suggests the results should be widely applicable for most heart failure patients.

One limitation is the study did not include a placebo or no-treatment control group. However, the fact that improvements persisted a full year after starting treatment, even with little ongoing therapist contact, suggests they were not due merely to placebo effects or natural recovery.

Future studies could investigate which types of patients respond best to psychotherapy vs. medication. For now, this research provides assurance that non-drug behavioral treatments are a viable choice for alleviating depression in heart failure--and may provide broader physical benefits as well. As scientists continue searching for ways to lift the mental burden of chronic disease, it's empowering for patients to know they have options beyond the pill bottle.

For more information on natural approaches to heart failure recovery, visit our database on the subject here.

For more natural strategies for treating depression, visit our database on the subject here.

For more information on the dangers of SSRI medications, visit our database on the subject here.


1. Tsabedze N, Kinsey JH, Mpanya D, Mogashoa V, Klug E, Manga P. The prevalence of depression, stress and anxiety symptoms in patients with chronic heart failure. Int J Ment Health Syst. 2021;15(1):44. doi:10.1186/s13033-021-00467-x

2. IsHak WW, Hamilton MA, Korouri S, et al. Comparative Effectiveness of Psychotherapy vs Antidepressants for Depression in Heart Failure: A Randomized Clinical Trial. JAMA Network Open. 2024;7(1):e2352094. doi:10.1001/jamanetworkopen.2023.52094

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