Antidepressants to Promote Recovery of Cardiac Patients Suffering From Depression
Antidepressants to Promote Recovery of Cardiac Patients Suffering From Depression
Depression is frequently seen in cardiac patients. It has been shown that depression often
 has a negative impact on the course of coronary disease. More recently, research has
 demonstrated that some antidepressants can be used safely to treat depressed coronary
 patients. Although the majority of patients improve substantially with antidepressant
 treatment, a significant proportion do not respond to antidepressants. This project seeks to
 better understand why depression does not improve equally well in all patients. Ultimately,
 the hope is to improve the treatments available to people affected by both cardiac disease
 and depression, and to help select the best type of treatment in advance for each individual
 based on his or her personal history, and biological characteristics.
In this study 140 patients who have had a recent hospitalization for an acute coronary
 syndrome and who have major depression will all receive 12 weeks of treatment with the
 antidepressant citalopram and regular clinical management visits from a mental health
 professional. The objective is to examine the characteristics of depressed cardiac patients
 who do and do not show an improvement in depression with citalopram treatment. There is
 evidence that the causes of depression may be different in some people with cardiac disease
 than in individuals who do not have heart problems, and these differences may be at least
 partially involved in determining response to antidepressant treatment. Inflammation, one of
 the body's responses to the development of atherosclerosis (hardening of the arteries and
 blockages in the heart) may be particularly important in producing depression in cardiac
 patients. There may also be changes in the body's metabolism of tryptophan, a protein that is
 involved in making serotonin, and levels of serotonin are often low in depression. Other
 factors thought to influence the development of depression include childhood experiences and
 personality factors. Heredity and family history also seem to play a role in some people with
 depression and heart disease. Finally, some patients experience sleep apnea, interruptions in
 breathing while they are asleep, that can contribute to both cardiac disease and depression.
Inclusion Criteria:

 -  At least 18 years old

 -  Diagnostic and Statical Manual-Revision 4 (DSM-IV) diagnosis of current MDD based on
 the Structured Clinical Interview for Depression (SCID)

 -  Duration of major depressive disorder (MDD) at least 4 weeks at baseline

 -  Hospital discharge for an acute coronary syndrome 4 to 24 weeks prior to baseline

 -  No coronary artery bypass (CABG) surgery during or since the admission for the index
 event, and no plan for CABG during the next 4 months after baseline

 -  Stable coronary artery disease (CAD) based on physician's clinical judgement

 -  Provision of informed consent

 Exclusion Criteria

 -  Significant cognitive problems (Mini-mental Status Exam, MMSE < 24) Structured
 Clinical Interview for Depression (SCID) documented bipolar disorder or use of lithium
 or anticonvulsants (e.g. tegretol, depakene, neurontin) for mood disorder

 -  MINI International Neuropsychiatric Interview (MINI) documented major depression with
 psychotic features

 -  MINI documented current or recent (within 12 months) substance abuse or dependence

 -  Serious suicide risk based on clinical judgment

 -  Currently taking antidepressants (including St. John's Wort)

 -  Absence of response to a previous adequate trial of citalopram

 -  Lifetime evidence of citalopram intolerance or lifetime evidence of intolerance to two
 or more other SSRIs

 -  2 or more previous unsuccessful trials of treatment for the current depressive episode

 -  Depression due to a general medical condition based on clinical judgment (e.g.,
 clinical hypothyroidism)

 -  Cold, flu or other infection or dental work (including teeth cleaning) in 14 days
 before baseline

 -  Use of antibiotics or steroids (other than topical steroids) in 14 days before
 baseline

 -  Participation in any randomized clinical trial

 -  Inability to speak French or English

 -  Investigator's judgement that patient is unable/unwilling to comply with study regimen