Article

Effects of Citalopram and Interpersonal Psychotherapy on Depression in Patients With Coronary Artery Disease

Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
JAMA The Journal of the American Medical Association (Impact Factor: 30.39). 02/2007; 297(4):367-79. DOI: 10.1001/jama.297.4.367
Source: PubMed

ABSTRACT Few randomized controlled trials have evaluated the efficacy of treatments for major depression in patients with coronary artery disease (CAD). None have simultaneously evaluated an antidepressant and short-term psychotherapy.
To document the short-term efficacy of a selective serotonin reuptake inhibitor (citalopram) and interpersonal psychotherapy (IPT) in reducing depressive symptoms in patients with CAD and major depression.
The Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy, a randomized, controlled, 12-week, parallel-group, 2 x 2 factorial trial conducted May 1, 2002, to March 20, 2006, among 284 patients with CAD from 9 Canadian academic centers. All patients met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for diagnosis of major depression of 4 weeks' duration or longer and had baseline 24-item Hamilton Depression Rating Scale (HAM-D) scores of 20 or higher.
Participants underwent 2 separate randomizations: (1) to receive 12 weekly sessions of IPT plus clinical management (n = 142) or clinical management only (n = 142) and (2) to receive 12 weeks of citalopram, 20 to 40 mg/d (n = 142), or matching placebo (n = 142).
The primary outcome measure was change between baseline and 12 weeks on the 24-item HAM-D, administered blindly during centralized telephone interviews (tested at alpha = .033); the secondary outcome measure was self-reported Beck Depression Inventory II (BDI-II) score (tested at alpha = .017).
Citalopram was superior to placebo in reducing 12-week HAM-D scores (mean difference, 3.3 points; 96.7% confidence interval [CI], 0.80-5.85; P = .005), with a small to medium effect size of 0.33. Mean HAM-D response (52.8% vs 40.1%; P = .03) and remission rates (35.9% vs 22.5%; P = .01) and the reduction in BDI-II scores (difference, 3.6 points; 98.3% CI, 0.58-6.64; P = .005; effect size = 0.33) also favored citalopram. There was no evidence of a benefit of IPT over clinical management, with the mean HAM-D difference favoring clinical management (-2.26 points; 96.7% CI, -4.78 to 0.27; P = .06; effect size, 0.23). The difference on the BDI-II did not favor clinical management (1.13 points; 98.3% CI, -1.90 to 4.16; P = .37; effect size = 0.11).
This trial documents the efficacy of citalopram administered in conjunction with weekly clinical management for major depression among patients with CAD and found no evidence of added value of IPT over clinical management. Based on these results and those of previous trials, citalopram or sertraline plus clinical management should be considered as a first-step treatment for patients with CAD and major depression.
isrctn.org Identifier: ISRCTN15858091.

Download full-text

Full-text

Available from: Louis T van Zyl, Mar 21, 2014
0 Followers
 · 
403 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To examine the antidepressant efficacy of a dual-acting antidepressant (mirtazapine) in patients with post-myocardial infarction (MI) depressive disorder. Antidepressants used in post MI trials with a randomized, double-blind, placebo-controlled design have been restricted to selective serotonin reuptake inhibitors (SSRIs). Antidepressant effects have been limited. In a prospective multicenter study, 2177 patients with MI were evaluated for depressive disorder during the first year post MI. Ninety-one patients who met the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria for major or minor depressive disorder were randomized to a 24-week, double-blind, placebo-controlled trial. Antidepressant efficacy was tested using last-observation-carried-forward procedure and repeated measurements analysis using the SPPS mixed models approach, with as primary outcome reduction in depressive symptomatology on the 17-item Hamilton-Depression Rating Scale (Ham-D), and secondary outcomes the Beck Depression Inventory (BDI) and depression subscale of the Symptom Check List 90 items (dSCL-90) as well as the Clinical Global Impression (CGI) scale. Using the "last observation carried forward" (LOCF) method, mirtazapine did not show to be superior to placebo on the Ham-D, but did on the BDI, dSCL-90, and CGI scale over the acute treatment phase of 8 weeks (n = 91). Using mixed models analysis over the entire 24 weeks of treatment (n = 40), we did find a significant difference favoring mirtazapine to placebo on the Ham-D, BDI, and CGI, but on the dSCL-90, this difference was not significant. This trial shows efficacy of mirtazapine on primary and secondary depression measures. Mirtazapine seems to be safe in the treatment of post-MI depression.
    Psychosomatic Medicine 01/2007; 69(7):606-13. DOI:10.1097/PSY.0b013e31814b260d · 4.09 Impact Factor
  • Source
    Michigan medicine 107(3):24-6.
  • [Show abstract] [Hide abstract]
    ABSTRACT: After acute coronary syndrome (ACS), patients have a significantly higher incidence of depression compared to the average healthy adult. Depression is independently associated with poorer outcomes and heightens the morbidity and mortality risk in this susceptible population. Selective serotonin reuptake inhibitors (SSRIs) are a newer class of antidepressants recently investigated for use in this population. This article reviews the current research on the safety, efficacy, possible benefits, and limitations of this class of antidepressants for patients with post-ACS. Information was obtained through a literature search of the electronic databases CINAHL, EMBASE, Ovid Medline (R), and PubMed Plus during the months of January and February of 2007. Keywords searched included acute coronary syndrome, myocardial infarction, selective serotonin reuptake inhibitors, sertraline, paroxetine, fluoxetine, depressive disorder, major depression, and depression. Results were then limited to the English language, adult population, publication years 2002-2007, and primary research articles. The search was broadened to include years 2000-2002. Abstracts were reviewed for applicability. All studies meeting the criteria for research articles of SSRI use in depressed patients with post-ACS were included. This amounted to 6 articles. Independent extraction was conducted by a single observer. Recent research shows positive outcomes associated with the use of SSRIs for depressed patients with post-ACS. The greatest benefit from these medications appears to be in the recurrently and severely depressed subpopulations. Although the use of SSRIs in patients with post-ACS appears to be associated with a decrease in morbidity and mortality rates, large, randomized control trials are still needed to support this finding.
    The Journal of cardiovascular nursing 01/2008; 23(6):489-96. DOI:10.1097/01.JCN.0000338929.89210.af · 1.81 Impact Factor