A double-blind, placebo-controlled treatment trial of citalopram for major depressive disorder in older patients with heart failure: the relevance of the placebo effect and psychological symptoms.
BACKGROUND
Little is known about the treatment of depression in older patients with heart failure. This study was developed to investigate the effectiveness of antidepressant treatment for major depressive disorder (MDD) in the elderly with heart failure.


METHODS
We enrolled 72 older outpatients with ejection fraction <50 and diagnosed with MDD by the structured clinical interview for DSM-IV. Thirty-seven patients, 19 on citalopram and 18 on placebo, initiated an 8-week double-blind treatment phase. Measurements were performed with the 31-item Hamilton Rating Scale for Depression (Ham-D-31), the Montgomery-Asberg rating scale (MADRS) and the Systematic Assessment for Treatment Emergent Effects (SAFTEE). A psychiatrist followed up the patients weekly, performing a consultation for about 20 min to field complaints after the measurements.


RESULTS
A trend toward superiority of citalopram over placebo in reducing depression was observed in MADRS scores (15.05+9.74 vs 9.44+9.25, P=.082) but not on HAM-D scores. The depressive symptomatology significantly decreased in both groups (P < .001). The high rate of placebo response during the double-blind phase (56.3%) led us to conclude the study at the interim analysis with 37 patients.


CONCLUSIONS
Citalopram treatment of MDD in older patients with heart failure is well-tolerated with low rates of side effects, but was not significantly more effective than placebo in the treatment of depression. Weekly psychiatric follow-up including counseling may contribute to the improvement of depression in this population. Scales weighted on psychological symptoms such as the MADRS are possibly better suited to measure depression severity and improvement in patients with heart failure.
Fraguas
Renerio
R
Department and Institute of Psychiatry, Clinics Hospital, Faculty of Medicine, University of Sao Paulo, SP, Brazil. rfraguas@hcnet.usp.br
da Silva Telles
Renata Martinho
RM
Alves
Tânia Correa Toledo Ferraz
TC
Andrei
Anna Maria
AM
Rays
Jairo
J
Iosifescu
Dan V
DV
Wajngarten
Mauricio
M
D000368:Aged; D000369:Aged, 80 and over; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D015283:Citalopram / Q000009:adverse effects / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D004311:Double-Blind Method; D005080:Exercise Test / Q000187:drug effects; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000523:psychology*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D010555:Personality Inventory / Q000706:statistics & numerical data; D015990:Placebo Effect; D011594:Psychometrics
D018687:Antidepressive Agents, Second-Generation; D015283:Citalopram