Citalopram effective and safe as first-line treatment for depressed patients with CAD
Patients with symptoms of depression who have coronary artery disease show improvement with citalopram, but adding psychotherapy does not provide extra benefit, according to a study (JAMA 2007;
297:367).
Previous trials have demonstrated the safety and efficacy of sertraline
in coronary artery disease (CAD) patients but now the “cardiac
randomised evaluation of antidepressant and psychotherapy efficacy” (CREATE)
trial conducted in Canada has established citalopram as a treatment option.
Researchers randomised 284 CAD patients with moderate to severe depression
to receive either 12 weekly sessions of interpersonal psychotherapy (ITP)
plus clinical management (n=142) or clinical management alone (n=142).
The patients then underwent a second randomisation and received either
12 weeks of citalopram or placebo. The mean dose of citalopram by the
end of the trial period was 33.1mg ±10.82mg.
Clinical management involved weekly sessions giving information about
depression and encouraging adherence to medication. The primary outcome
measure was change from baseline on the 24-item Hamilton Depression Rating
Scale (HAM-D).
The researchers found that citalopram was better than placebo at reducing
HAM-D scores by a mean of 3.3 points (96.7 per cent confidence interval
0.80-5.85; P=0.005), an effect size of 0.33. There were no differences
between citalopram and placebo in any blood pressure or electrocardiographic
measures. Although patients improved on both IPT and clinical management,
there was no evidence of superiority for IPT and no difference in remission
and relapse rates.
The authors conclude: “Citalopram or sertraline plus clinical management
should be considered for the initial acute-phase treatment of major depression
in patients with CAD.”
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