Exercise to Treat Depression in Individuals With Coronary Heart Disease (UPBEAT)

Inclusion Criteria: Persistent depressive symptoms that may include the following: depressed mood; diminished interest or pleasure in activities; change in appetite; insomnia or hypersomnia; psychomotor agitation or retardation; fatigue or loss of energy; feelings of worthlessness or inappropriate guilt; diminished ability to think or concentrate; or recurrent thoughts of death or suicidal ideations Documented history of coronary heart disease (i.e., a prior heart attack, coronary artery bypass graft, or greater than 75% stenosis in at least one coronary artery) Exclusion Criteria: Experienced an acute heart attack or any revascularization procedure (i.e., CABG or percutaneous transluminal coronary angioplasty) within 60 days of study entry Left ventricular ejection fraction <30% with labile ECG changes prior to testing Currently using a pacemaker Resting blood pressure greater than 160/100 mmHg Left main disease >50% Failure to meet our criteria for depression or achieve a score of ≥9 on the Beck Depression Inventory-II Any other concurrent psychiatric intervention Primary psychiatric diagnosis other than Major or Minor Depressive Episode Primary diagnosis of the following psychiatric disorders: schizophrenia, bipolar disorder, schizoaffective disorder, other psychotic disorder, dementia, current delirium, current obsessive compulsive disorder Experienced psychotic symptoms during the current depressive episode Current abuse or dependence on alcohol or other drugs Acute suicide risk Patients who, during the course of the study, would likely require treatment with additional psychotherapeutic agents Significant medical conditions that would make exercise or sertraline use medically inadvisable (e.g., unstable angina, heart attack within the 3 months prior to study entry, musculoskeletal problems, or congestive heart failure) Abnormal thyroid-stimulating hormone (TSH) level and glucose level greater than or equal to 126 mg/dL Patients who would not be able to be randomized to either the drug (e.g., adverse cardiac events such as prolonged QT interval, allergic responses) or exercise (e.g., musculoskeletal problems, abnormal cardiac response to exercise, such as exercise-induced VT, abnormal blood pressure response, etc.) Currently using medications that would make exercise or sertraline use medically inadvisable (e.g., clonidine, dicumarol, warfarin, anticonvulsants, or MAO inhibitors) Current uncontrolled medical condition that could be causing the depressive symptoms (e.g., thyroid dysfunction, anemia) Pregnant, planning to get pregnant during the study period, or lactating Herbal supplements with purported mood effects (e.g., St. John's wort, valerian, gingko) Current use of antidepressant medication Currently participating in psychotherapy Currently participating in regular aerobic exercise Documented failure to respond to sertraline therapy