Beating the Blues for Your Heart (BtB-Heart)

• Change in Brachial Flow-Mediated Dilation (FMD) at 12 Weeks [ Time Frame: 0 and 12 weeks ] [ Designated as safety issue: No ]
  Patients will undergo ultrasound assessment of brachial FMD in accordance with established guidelines. After a 10-minute supine rest, high-resolution baseline images of the brachial artery will be obtained from 3 consecutive cardiac cycles. Next, the forearm cuff will be inflated to 250 mmHg for 5 minutes and then will be rapidly deflated. At 60 and 90 seconds post-deflation, images from 3 consecutive cardiac cycles will be acquired. FMD values will be computed as the % increase in brachial diameter at either 60 or 90 seconds after cuff deflation.
  
  

• Change in Depressive Symptoms Severity at 12 Weeks [ Time Frame: 0, 6, and 12 Weeks ] [ Designated as safety issue: No ]
  Self-reported depressive symptom severity (SCL-20 score)
  
  
• Change in Poor Health Behaviors at 12 Weeks [ Time Frame: 0, 6, and 12 weeks ] [ Designated as safety issue: No ]
  Self-reported smoking, physical inactivity, and cardiovascular medication and lifestyle adherence.
  
  
• Change in Autonomic Nervous System Function at 12 Weeks [ Time Frame: 0 and 12 weeks ] [ Designated as safety issue: No ]
  High-frequency heart rate variability (HRV) and pre-ejection period (PEP)
  
  
• Change in Circulating Markers of Systemic Inflammation at 12 Weeks [ Time Frame: 0 and 12 weeks ] [ Designated as safety issue: No ]
  Plasma C-reactive protein(CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha).
  
  

Depression is an independent risk factor for coronary artery disease (CAD); unfortunately, past trials have not detected a cardiovascular benefit. A promising and unexplored explanation for these results is that the interventions were delivered too late in the natural history of CAD. Because no study has evaluated this possibility, there is a critical need to determine whether evidence-based depression treatment, delivered before the onset of clinical CAD, reduces cardiovascular risk. Accordingly, the objective of the proposed clinical and translational research is to perform a preliminary evaluation of the efficacy of a highly disseminable depression intervention in decreasing CAD risk. To achieve this goal, a clinical trial of depressed primary care patients free of cardiovascular disease is being conducted. Patients will be randomized to usual care or a computer-based, cognitive behavioral intervention called Beating the Blues®, the most widely used and empirically supported computerized treatment program for depression. The primary outcome is brachial artery flow-mediated dilation, a noninvasive measure of endothelial function. The specific aim of the proposed trial is to evaluate whether Beating the Blues®, delivered prior to the onset of clinical CAD, improves endothelial dysfunction. Demonstrating that earlier treatment of depression with Beating the Blues lowers CAD risk, the long-term expected outcome, would place computed-based depression treatment in the armamentarium of CAD prevention strategies of the primary care provider. This change to clinical practice should result in improved cardiovascular risk management, which in turn would translate into reduced CAD morbidity and mortality.