Effects of citalopram and interpersonal psychotherapy on depression in patients with coronary artery disease -: The Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) trial

被引:439
作者
Lesperance, Francois
Frasure-Smith, Nancy
Koszycki, Diana
Laliberte, Marc-Andre
van Zyl, Louis T.
Baker, Brian
Swenson, John Robert
Ghatavi, Kayhan
Abramson, Beth L.
Dorian, Paul
Guertin, Marie-Claude
机构
[1] Univ Montreal, Ctr Hosp, Res Ctr, Montreal, PQ H2L 4M1, Canada
[2] Univ Montreal, Dept Psychiat, Montreal, PQ H3C 3J7, Canada
[3] Montreal Heart Inst, Res Ctr, Montreal, PQ H1T 1C8, Canada
[4] Montreal Heart Inst, Dept Psychosomat Med, Montreal, PQ H1T 1C8, Canada
[5] Montreal Heart Inst, Coordinating Ctr, Montreal, PQ H1T 1C8, Canada
[6] McGill Univ, Dept Psychiat, Montreal, PQ, Canada
[7] McGill Univ, Sch Nursing, Montreal, PQ, Canada
[8] Univ Ottawa, Dept Psychiat, Ottawa, ON K1N 6N5, Canada
[9] Univ Ottawa, Royal Ottawa Hosp, Mental Hlth Res Inst, Ottawa, ON, Canada
[10] Univ Ottawa, Inst Heart, Ottawa, ON, Canada
[11] Ottawa Hosp, Dept Psychiat, Ottawa, ON, Canada
[12] Queens Univ, Dept Psychiat, Kingston, ON K7L 3N6, Canada
[13] Kingston Gen Hosp, Kingston, ON K7L 2V7, Canada
[14] Univ Hlth Network, Dept Psychiat, Toronto, ON, Canada
[15] Univ Toronto, Dept Med, Toronto, ON, Canada
[16] St Michaels Hosp, Div Cardiol, Toronto, ON M5B 1W8, Canada
[17] St Michaels Hosp, Cardiac Prevent Ctr, Toronto, ON M5B 1W8, Canada
[18] Dalhousie Univ, Dept Psychiat, Capital Dist Hlth Author, Halifax, NS, Canada
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2007年 / 297卷 / 04期
关键词
D O I
10.1001/jama.297.4.367
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context Few randomized controlled trials have evaluated the efficacy of treatments for major depression in patients with coronary artery disease ( CAD). None have simultaneously evaluated an antidepressant and short-term psychotherapy. Objective To document the short-term efficacy of a selective serotonin reuptake inhibitor ( citalopram) and interpersonal psychotherapy (IPT) in reducing depressive symptoms in patients with CAD and major depression. Design, Setting, and Participants The Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy, a randomized, controlled, 12-week, parallel-group, 2 x 2 factorial trial conducted May 1, 2002, to March 20, 2006, among 284 patients with CAD from 9 Canadian academic centers. All patients met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for diagnosis of major depression of 4 weeks' duration or longer and had baseline 24-item Hamilton Depression Rating Scale (HAM-D) scores of 20 or higher. Interventions Participants underwent 2 separate randomizations: ( 1) to receive 12 weekly sessions of IPT plus clinical management (n=142) or clinical management only (n=142) and ( 2) to receive 12 weeks of citalopram, 20 to 40 mg/d (n=142), or matching placebo (n=142). Main Outcome Measures The primary outcome measure was change between baseline and 12 weeks on the 24-item HAM-D, administered blindly during centralized telephone interviews ( tested at alpha=.033); the secondary outcome measure was self-reported Beck Depression Inventory II (BDI-II) score ( tested at alpha=.017). Results Citalopram was superior to placebo in reducing 12-week HAM-D scores ( mean difference, 3.3 points; 96.7% confidence interval [CI], 0.80-5.85; P=. 005), with a small to medium effect size of 0.33. Mean HAM-D response (52.8% vs 40.1%; P=. 03) and remission rates (35.9% vs 22.5%; P=. 01) and the reduction in BDI-II scores ( difference, 3.6 points; 98.3% CI, 0.58-6.64; P=. 005; effect size=0.33) also favored citalopram. There was no evidence of a benefit of IPT over clinical management, with the mean HAM-D difference favoring clinical management (- 2.26 points; 96.7% CI, - 4.78 to 0.27; P=. 06; effect size, 0.23). The difference on the BDI-II did not favor clinical management (1.13 points; 98.3% CI, - 1.90 to 4.16; P=. 37; effect size=0.11). Conclusions This trial documents the efficacy of citalopram administered in conjunction with weekly clinical management for major depression among patients with CAD and found no evidence of added value of IPT over clinical management. Based on these results and those of previous trials, citalopram or sertraline plus clinical management should be considered as a first-step treatment for patients with CAD and major depression.
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页码:367 / 379
页数:13
相关论文
共 57 条
[1]   Executive dysfunction, heart disease burden, and remission of geriatric depression [J].
Alexopoulos, GS ;
Kiosses, DN ;
Murphy, C ;
Heo, M .
NEUROPSYCHOPHARMACOLOGY, 2004, 29 (12) :2278-2284
[2]   Establishing specificity in psychotherapy: A meta-analysis of structural equivalence of placebo controls [J].
Baskin, TW ;
Tierney, SC ;
Minami, T ;
Wampold, BE .
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY, 2003, 71 (06) :973-979
[3]   CITALOPRAM IN DEPRESSION - METAANALYSIS OF INTENDED AND UNINTENDED EFFECTS [J].
BECH, P ;
CIALDELLA, P .
INTERNATIONAL CLINICAL PSYCHOPHARMACOLOGY, 1992, 6 :45-54
[4]  
Beck A. T., 1996, BDI-II: Beck Depression Inventory-II Manual, V2th ed.
[5]  
Berkman L, 2001, PSYCHOSOM MED, V63, P747
[6]  
Berkman LF, 2003, JAMA-J AM MED ASSOC, V289, P3106
[7]   Dual randomization in cardiovascular trials [J].
Califf, RM .
AMERICAN HEART JOURNAL, 2000, 140 (01) :1-1
[8]  
Campeau L, 2002, CAN J CARDIOL, V18, P371
[9]   Secondary endpoints can be validly analyzed, even if the primary endpoint does not provide clear statistical significance [J].
Davis, CE .
CONTROLLED CLINICAL TRIALS, 1997, 18 (06) :557-560
[10]   A systematic review of research findings on the efficacy of interpersonal therapy for depressive disorders [J].
de Mello, MF ;
Mari, JD ;
Bacaltchuk, J ;
Verdeli, H ;
Neugebauer, R .
EUROPEAN ARCHIVES OF PSYCHIATRY AND CLINICAL NEUROSCIENCE, 2005, 255 (02) :75-82