Citalopram, but not interpersonal psychotherapy, improves major depression in people with coronary artery disease.

摘要

As evidence accumulates that cardiac patients with depression are at increased risk for adverse outcomes, it is imperative to prove the efficacy of depression treatment. Data from clinical trials, however, are limited., SADHART demonstrated that sertroline safely and effectively improved depressive symptoms in people with acute coronary syndrome, but,was underpowered for other .outcomes.1 ENRICHD found that-cognitive behaviour therapy improved depressive symptoms in post-Mi patients., but "did not reduce mortality. However, a post hoc analysis suggeted-that SSR1 usewas associated with a lower risk of the death or Ml. The research community ond practicing clinicians are left wifh a body of evidence linking depression and cardiovascular disease, but few -answers "about best treatment strategies and the influence of depression treatment on outcomes.CREATE is the first trial to evaluate the efficacy of the SSRI citolopram and interpersonal psychotherapy .(IPT) in cardiac patients, with depres-sion.CREATE found that citalopram was effective in improving depressive symptoms compared with placebo. However, there was no evidence of an added value of jPT over v/eeidy clinical .management (brief education, reassurance, and encouragement ?of adherence to medication). The principal clinical implication of CREATE, in the context of prior studies including evidence that SSRi medications have antiplatelet/anti-infianv matory effects/ is that citalopram or seiiraline plus clinical management are the treatments of choice for depressed cardiac patients.The body of evidence to date, capped by CREATE, proves that depression is common, adversely prognostic, and can be treated in cardiac populations. However, .depression recognition and treatment in real-world clinical practice appears dismal, ond the impact on patient outcomes beyond depressive symptoms is largely" unknown. CREATE should mark the beginning of a new era-one of studies evaluating how depression can be better recognised and treated in routine" clinical practice,and whether depression treatment in cardiac populations can reduce mortality (all-cause and cardiovascular), reduce hospitafisations, improve medication -adherence, reduce resource use, and improve patient health status. In the meantime, practicing clinicians should not hesitate to