This 12-week study will test the efficacy of cognitive behavioral therapy and stress management therapy as treatments for depression in people who have recently undergone coronary artery bypass graft surgery.

Depression is a very common problem for people who have had CABG surgery. It is associated with concentration and memory problems, and recent studies have shown that it may increase the risk of additional medical problems and death during the first few years after surgery. Both CBT and SM therapy have been shown to be effective in the treatment of depression in otherwise healthy individuals. These therapies have not, however, been tested for depression in individuals who have undergone CABG surgery.

Participants are screened for depression within 1 year after surgery. Those who have depression return for additional testing 1 week later. Patients are then randomized to receive CBT, SM, or usual care (with no restriction on nonstudy antidepressants) for 12 weeks. Patients are monitored for worsening depression and are referred for additional care if needed. Depression outcomes, which include daily activities, concentration and memory, and quality of life, are assessed 12 weeks after randomization and 6 months after surgery (2 months after termination of CBT or SM).

• Depression
• Coronary Disease

• Behavioral: Cognitive behavior therapy
• Behavioral: Supportive Stress Management

• Experimental: Cognitive Behavior Therapy
• Active Comparator: Supportive Stress Management
• No Intervention: Usual Care

Inclusion Criteria:

• Coronary Artery Bypass Graft (CABG) surgery (alone or combined with valvular or carotid surgery) within past 12 months
• Meets DSM-IV criteria for major or minor depressive episode

Exclusion Criteria:

• Severe cognitive impairment
• Severe psychiatric comorbidity (e.g., alcoholism or schizophrenia)
• Severely debilitating or life-threatening illness other than coronary disease