Grant: Operating Grant: Prevention of Cardiovascular and Respiratory Diseases

Patients with coronary artery disease (CAD) are more likely to be depressed than people in the general community. Depression also predicts worse prognosis in CAD patients. Although no trials have shown that treating depression reduces risk in CAD patients, depression is also associated with decreased quality of life and daily functioning. Sub-group results from the two largest depression treatment studies in CAD patients (including our CIHR-funded study CREATE) show that patients with first depressions are less likely to respond to antidepressants than those with previous depressions. To improve care for depressed CAD patients, we need to know whether this difference is also true outside of clinical trials involving randomization to placebo, and to determine factors explaining the difference. We plan to compare predictors of depression changes between CAD patients with first and recurrent episodes of depression who have had recent cardiac events. All will be treated with citalopram for 12 weeks and receive regular clinical management (CM). The sample of 140 will include equal numbers of men and women, and equal numbers with first and recurrent depressions. We hypothesize that patients with a first depression will show less depression change with citalopram treatment than those who have had previous depressions; and that they will have higher levels of inflammatory markers and more evidence of dysregulation of the serotonin system. Further, these patterns will be true for women and men. If the hypotheses are supported, it will establish that depression treatment strategies should be differentially tailored for patients with first and recurrent depressions who have had recent cardiac events. Regular CM and SSRI antidepressant treatment may be sufficient for most with previous depressions, but additional treatments targeting inflammation and/or tryptophan metabolism are likely be needed for many with a first depression.