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The researchers found that enhanced care interventions, which integrate psychiatric treatment into other clinical settings, improve depression symptoms, although not necessarily cardiac outcomes. These tools include: Fourteen articles representing four studies examined the comparative safety and effectiveness of pharmacologic and non-pharmacologic treatments and enhanced care delivery approaches to usual care for the treatment of depression in people following an ACS event.

The other authors report no financial relationships with commercial interests.

This summation has been developed independently of the authors. Uher is supported by the Canada Research Chairs Program (file number 950-225925). Aitchison holds an Alberta Centennial Addiction and Mental Health Research Chair, funded by the Government of Alberta. Henigsberg has participated in clinical trials sponsored by Lundbeck, Takeda, Glaxo Smith Kline, and Pfizer. Souery has served on advisory boards for, and received unrestricted grants from, Lundbeck and Astra Zeneca. Aitchison has been a member of various advisory boards, received consultancy fees and honoraria, and has received research grants from various companies including Johnson and Johnson Pharmaceuticals Research and Development and Bristol-Myers Squibb Pharmaceuticals Limited. Farmer and Mc Guffin have received honoraria for participating in expert panels for Lundbeck and Glaxo Smith Kline.

However, the screenings have a high rate of false positives; they identify 50% more people as having depression than are confirmed in an clinical diagnosis. The researchers conducted intent-to-treat analyses from November 2015 to January 2017.

Although depression is common among people following an ACS event, the evidence base is insufficient to determine if treating the depression improves cardiac outcomes. For this analysis, the researchers investigated a potential dose-response between the number of e CBT sessions completed, and a sub- analysis restricted to those who completed 4 or more and all 8 e CBT sessions.

The evidence based indicated that combining cognitive behavioral therapy and antidepressants may improve depression outcomes. The participants were required to have Internet and email access, and a score of 10 or greater on either the 7-Item Generalized Anxiety Disorder scale (GAD-7) or the 9-Item Patient Health Questionnaire (PHQ), and no alcohol dependence, active suicidality, or other serious mental illness.