title: Antidepressant therapy in patients undergoing coronary artery bypass grafting: the MOTIV-CABG trial.
abstract: BACKGROUND
  The efficacy of antidepressant therapy in patients undergoing coronary artery bypass grafting (CABG) is not clearly established.
  
  
  METHODS
  This double-blind trial was conducted at University Hospital, Besançon, France. Adult CABG patients were randomized (1:1) to receive escitalopram (10 mg daily) or placebo from 2 to 3 weeks before to 6 months after surgery, including 12 months post-surgery follow-up. The primary composite endpoint was the occurrence of mortality or predefined morbidity events. Secondary endpoints included measures of depression, mental and physical health using Beck Depression Inventory Short Form (BDI), and quality of life 36-Item Short Form (SF-36) self assessments.
  
  
  RESULTS
  The treated cohort contained 361 patients with mean age 67 years. At 12 months, the proportions of patients with the composite morbidity and mortality endpoint were not different between escitalopram and placebo (110 of 182 [60.4%] vs 108 of 179 [60.3%], p = 0.984). However, over the 6 months postoperative period, the BDI and SF-36 Mental Component Summary scores were better overall in the escitalopram group than in the placebo group for all patients (p = 0.015 and p = 0.014, respectively) and preoperatively depressed (BDI > 3) patients (p = 0.002 and p = 0.005, respectively). Moreover, the SF-36 Pain score was better overall in the escitalopram group than in the placebo group in the preoperatively-depressed subset (p = 0.026).
  
  
  CONCLUSIONS
  Antidepressant therapy had no effect on morbidity and mortality events up to 1 year after CABG. However, antidepressant therapy may provide faster improvements to mental health aspects of quality of life and reduce postoperative pain in patients with preoperative depression. Subject to contra-indications, we recommend antidepressant therapy in coronary revascularization patients who are preoperatively depressed.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, EA3920, University Hospital Jean Minjoz, Besançon, France. sidney.chocron@univ-fcomte.fr
authors.forename: Sidney
authors.initials: S
authors.lastname: Chocron
authors.forename: Pierre
authors.initials: P
authors.lastname: Vandel
authors.forename: Camille
authors.initials: C
authors.lastname: Durst
authors.forename: Frédéric
authors.initials: F
authors.lastname: Laluc
authors.forename: Djamel
authors.initials: D
authors.lastname: Kaili
authors.forename: Michael
authors.initials: M
authors.lastname: Chocron
authors.forename: Joseph-Philippe
authors.initials: JP
authors.lastname: Etievent
mesh_terms: D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D015283:Citalopram / Q000627:therapeutic use*; D001026:Coronary Artery Bypass / Q000401:mortality / Q000523:psychology*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*
chemical_list: D018687:Antidepressive Agents, Second-Generation; D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors