As many as 15–20% of patients with coronary heart disease (CHD) suffer from a major depressive disorder, and a further 20% have symptoms of depression. Morbidity and mortality are increased in these patients. The UPBEAT study investigators now report that either exercise or antidepressant medication effectively reduces symptoms of depression in patients with CHD.

A total of 101 patients with documented CHD and a score ≥7 on the Beck Depression Inventory were randomly allocated to supervised aerobic exercise (30 min three times per week), the selective serotonin reuptake inhibitor sertraline (50–200 mg per day), or a placebo pill. The primary end point was Hamilton Rating Scale for Depression score at the end of the 16-week follow-up compared with at enrollment. Larger reductions in the score were achieved with either exercise (mean −7.5) or sertraline (mean −6.1) than with placebo (mean −4.5; P = 0.034). Heart-rate variability—an important cardiovascular biomarker—also tended to improve more in patients with exercise than in those receiving sertraline or placebo.

Few adverse effects were reported, but sertraline was associated with more fatigue and sexual dysfunction than exercise or placebo. These data indicate that exercise is as good as, or better than, sertraline at improving symptoms of depression and quality of life in patients with CHD, with fewer adverse effects.