Research performed over the last 15 years has found that depression often accompanies coronary artery disease (CAD). A new study finds that an antidepressant medication improves symptoms of depression. However, short-term psychotherapy did not appear to offer additional benefits for patients in the acute phase of depression brought upon by heart disease.
Since the early 1990s, studies have reported that 17 – 27 percent of hospitalized patients with coronary artery disease (CAD) also have major depression. The depression is generally thought to have a negative impact on cardiac outcomes.
According to a study in the current issue of the Journal of the American Medical Association (JAMA), a selective serotonin reuptake inhibitor (SSRI) improves symptoms of depression although short-term psychotherapy did not appear to offer additional benefit.
Researchers evaluated the short-term effectiveness and tolerability of two depression treatments in patients with CAD: citalopram, a selective serotonin reuptake inhibitor (SSRI) antidepressant and interpersonal psychotherapy (IPT), a short-term, manual-based psychotherapy focusing on the social context of depression.
The 12-week study included 284 patients with CAD from nine Canadian academic centers and was conducted from May 2002 to March 2006. All patients met criteria for a diagnosis of major depression of four weeks’ duration or longer.
Participants were randomized: (1) to receive either 12 weekly sessions of IPT plus clinical management (n = 142) or clinical management only (n = 142) and (2) to receive either 12 weeks of citalopram (n = 142), or matching placebo (n = 142).
Clinical management involved weekly sessions with information about depression and medication use, reassurance, and encouragement of adherence to medication and the study protocol.
Interpersonal psychotherapy involved sessions dealing with problems common in patients with CAD, including interpersonal conflicts, life transitions, grief, and loss.
The researchers found that citalopram was superior to placebo in reducing depressive symptoms in all efficacy measures. The remission and response rates and average changes on a depression measurement scale also consistently favored citalopram over placebo. The superiority of citalopram was apparent by 6 weeks.
Although patients improved with both IPT and clinical management, there was no evidence of superiority for IPT, and remission and response rates did not differ between those two treatments.
The authors add that the benefits of citalopram extended to changes in perceived social support and daily function.
“Citalopram (or sertraline, as previously shown in [a different] trial) plus clinical management should be considered for the initial acute-phase treatment for major depression in patients with CAD. It remains to be demonstrated that any form of psychotherapy is superior to clinical management in reducing depression symptoms in this group,” the researchers conclude.