Design and rationale for a randomized, controlled trial of interpersonal psychotherapy and citalopram for depression in coronary artery disease (CREATE).
OBJECTIVE
Recognition that depression is associated with increased morbidity and mortality in coronary artery disease (CAD) patients has augmented the need for evidence-based treatment guidelines. This article presents the design of a multisite, Canadian trial of the efficacy, safety, and tolerability of interpersonal psychotherapy (IPT), an empirically supported, depression-focused therapy, and the selective serotonin reuptake inhibitor citalopram, alone or in combination, in the treatment of major depression in CAD patients.


METHODS
Two hundred eighty stable CAD patients with a current major depressive episode of at least 4 weeks' duration, based on the Structured Clinical Interview for Depression (SCID), and who have a baseline score >19 on a centralized, telephone-administered, 24-item Hamilton Depression Rating Scale (HAM-D) will be randomly assigned to receive 12 weekly IPT sessions or 12 weekly sessions of standardized clinical management (CM). Patients are also randomly assigned to receive 20 to 40 mg per day of citalopram or pill-placebo. This results in a 2-by-2 factorial design with four groups: IPT plus pill-placebo, IPT plus citalopram, CM plus pill-placebo, and CM plus citalopram. This permits the evaluation of both IPT and citalopram. Blinded, centralized, 24-item, HAM-D telephone ratings constitute the primary outcome variable. The self-report Beck Depression Inventory-II is the secondary outcome. Analyses will involve the intent-to-treat principle with last observation carried forward for incomplete assessments.


RESULTS
Not applicable.


CONCLUSIONS
The results of this trial will contribute to the development of evidence-based clinical guidelines for managing depression in the context of CAD.
Frasure-Smith
Nancy
N
Department of Psychiatry, McGill University, Montreal Canada. nancy.frasure-Smith@mcgill.ca
Koszycki
Diana
D
Swenson
John Robert
JR
Baker
Brian
B
van Zyl
Louis T
LT
Laliberté
Marc-André
MA
Abramson
Beth L
BL
Lambert
Jean
J
Gravel
Ginette
G
Lespérance
François
F
D015283:Citalopram / Q000627:therapeutic use*; D003324:Coronary Artery Disease / Q000150:complications*; D003865:Major Depressive Disorder / Q000150:complications / Q000628:therapy*; D006801:Humans; D011613:Psychotherapy; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome
D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors