Biological Psychiatry Congress 2007

Abstract

Background: Depressive symptoms and major depressive disorder (MDD) occur ≥ 3 times as common in coronary artery disease (CAD) patients as in the general community, which confers an adjusted relative risk of 2 to 4 for mortality. There are emerging data on how to manage depressed CAD patients with MDD.

Method: The two previous clinical trials (SADHART and ENRICHD) confirm (i) failure of cognitive-behavior therapy to affect survival, (ii) improvement with placebo and usual care, (iii) clinical effect of sertraline, particularly in those with recurrent MDD, (iv) cardiac safety of sertraline. This presentation will highlight the findings of the recently concluded CREATE (Canadian cardiac evaluation of antidepressant and psychotherapy efficacy) study.

Results: In a 2-by-2 factorial trial 284 patients with stable CAD were assigned to interpersonal psychotherapy (IPT) or clinical management (CM) and citalopram or placebo for 12 weeks. Citalopram reduced depressive symptoms more than placebo at 6 weeks (p=.01) and at 12 weeks (HAM-D-Hamilton Depression difference 3.3 points, p=.005). Citalopram was efficacious for 43% with recurrent depression compared to those experiencing MDD for the first time. However, there was no additional benefit of adding IPT to CM (HAM-D difference -2.3 points; p=.06), favoring CM over IPT in lowering depressive symptoms. IPT improved depression compared to CM for those subjects with high levels of functional performance. There were 12 cardiovascular and 23 other serious adverse events classified by independent committee and no electrocardiogram effects of the active drug were noted.

Conclusion: Citalopram can be considered as a first line treatment of MDD in CAD patients. So far, besides CM, it has not been shown if any form of psychotherapy is indicated for such patients.