Magazine article Clinical Psychiatry News

Citalopram Bests Placebo in Depressed CAD Patients

Magazine article Clinical Psychiatry News

Citalopram Bests Placebo in Depressed CAD Patients

Article excerpt

TUCSON, ARIZ. -- A randomized, multicenter Canadian trial testing interpersonal psychotherapy and citalopram in 284 depressed patients with stable coronary artery disease produced mixed results, investigators reported at the annual meeting of the Academy of Psychosomatic Medicine.

Citalopram (Celexa) was significandy more effective than placebo, reducing Hamilton Depression Rating scale (HAM-D) scores by an additional 3.3 points on average, according to Dr. Francois Lesperance, principal investigator of the Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) trial. Adding interpersonal psychotherapy (IPT) to 12 weekly clinical management sessions was a disappointment, however. Short-term therapy was no more effective in relieving depression than clinical management alone.

The Canadian Institutes of Health Research gave the CREATE trial a $1,342,996 (Canadian) grant. Starting in 2002, the study enrolled patients in Montreal, Kingston, Ottawa, and Toronto. Faced with slow enrollment, it added sites in Halifax and Calgary.

To maximize resources, investigators randomized patients twice under a 2-by-2 factorial trial design. Participants comprised four cohorts: IPT/clinical management and citalopram (67 patients), IPT/clinical management and placebo (75 patients), clinical management alone and citalopram (75 patients), and clinical management alone and placebo (67 patients).

Consequently, the analyses were based on 142 patients exposed to IPT/clinical management vs. 142 patients exposed to clinical management alone and 142 citalopram patients vs. 142 treated with placebo.

The presentation did not address the combined effect of IPT and citalopram in patients given both therapies. Dr. Nancy Frasure-Smith, a coinvestigator, said the investigators neither expected nor saw any synergy between IPT and citalopram.

Dr. Frasure-Smith, a professor of psychiatry at McGill University in Montreal and senior research associate at the Montreal Heart Institute, emphasized that the trial used broad inclusion criteria.

She cited growing evidence that depression is a risk factor for heart disease, but said little is known about treating depression in coronary disease patients because most depression treatment trials exclude patients with comorbidities. …

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