In this issue of JAMA, Lespérance et al1 report the results of the Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) trial, a blinded, randomized controlled clinical trial testing the efficacy of the selective serotonin reuptake inhibitor (SSRI) citalopram and interpersonal psychotherapy in 284 patients with major depressive disorder. The efficacy of citalopram2 and interpersonal psychotherapy3 in the treatment of major depression in patients primarily free of coronary heart disease (CHD) is well documented. The clinical importance of CREATE is that it involved patients with comorbid CHD. Depression is a painful, functionally impairing, and frequently recurrent condition that in patients with either coronary or cerebral vascular disease also significantly increases the risk of cardiovascular morbidity and mortality. A recent report found 17 studies indicating that depression following a coronary event was associated with a 3-fold increase in cardiac mortality.4
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