BMJ  2007;334:230 (3 February), doi:10.1136/bmj.334.7587.230-a

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Citalopram lifts depression after heart disease

Patients with coronary artery disease are vulnerable to depression. Depression makes it harder for patients to follow lifestyle advice and stick to complex drug regimens; this increases the chance of further coronary events or even death. Some doctors aren't sure if this "natural" response to a life threatening event should be treated, but there's now reasonable evidence that selective serotonin reuptake inhibitors can help, at least in the short term.

In one recent trial, citalopram worked significantly better than placebo in 284 people with established stable heart disease and major depression. The drug reduced scores on various depression rating scales and increased the chance of a response to treatment. The psychotherapy arms of the same trial (which had a factorial design) were less successful. Controls who had weekly meetings to discuss symptoms and drugs did just as well, or even better on some measures, than patients who had weekly interpersonal psychotherapy. Neither treatment had serious cardiovascular side effects, but citalopram had side effects such as dizziness (49%), diarrhoea (49%), somnolence (43%), and sexual dysfunction (21%).

If selective serotonin reuptake inhibitors work for depressed people with heart disease they might also prolong survival or at least reduce the risk of further heart attacks, writes an editorial (pp 411-2). Much bigger trials are needed to find this out.

References

JAMA 2007;297:367-79[Abstract/Full Text] JAMA 2007;297:411-2[Full Text]

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