Escitalopram treatment for depressive disorder following acute coronary syndrome: a 24-week double-blind, placebo-controlled trial.
OBJECTIVE
Depression is common after acute coronary syndrome (ACS) and has adverse effects on prognosis. There are few evidence-based interventions for treating depression in ACS. This study investigated the efficacy and safety of escitalopram in treating depressive disorders identified 2-14 weeks after a confirmed ACS episode.


METHODS
A total of 217 patients with DSM-IV depressive disorders (121 major and 96 minor) and ACS were randomly assigned to receive escitalopram in flexible doses of 5-20 mg/d (n = 108) or placebo (n = 109) for 24 weeks. The study was conducted from 2007 to 2013. The primary outcome measure was the Hamilton Depression Rating Scale (HDRS). Secondary outcome measures included the Montgomery-Asberg Depression Rating Scale (MADRS), Beck Depression Inventory (BDI), Clinical Global Impressions-Severity of Illness scale (CGI-S), Social and Occupational Functioning Assessment Scale (SOFAS), and World Health Organization Disability Assessment Schedule-12. Cardiovascular safety outcomes included echocardiography, electrocardiography, laboratory test, body weight, and blood pressure results.


RESULTS
Escitalopram was superior to placebo in reducing HDRS scores (mean difference = 2.3, P = .016, effect size = 0.38). Escitalopram was also superior to placebo in decreasing depressive symptoms evaluated by the MADRS, BDI, and CGI-S and in improving SOFAS functioning level. Escitalopram was not associated with any harmful changes in cardiovascular safety measures. Dizziness was significantly more frequently reported in the escitalopram group (P = .018), but there were no significant differences in any other adverse events.


CONCLUSIONS
These results indicate that escitalopram has clinically meaningful antidepressant effects with no evidence of reduced cardiovascular safety in depressive disorder following ACS.


BACKGROUND
ClinicalTrials.gov identifier: NCT00419471.
Departments of Psychiatry, Cardiology, Biomedical Science, and Pharmacology, Chonnam National University Medical School.
Jae-Min
JM
Kim
Kyung-Yeol
KY
Bae
Robert
R
Stewart
Bo-Ok
BO
Jung
Hee-Ju
HJ
Kang
Sung-Wan
SW
Kim
Il-Seon
IS
Shin
Young Joon
YJ
Hong
Ju Han
JH
Kim
Hee-Young
HY
Shin
Gaeun
G
Kang
Youngkeun
Y
Ahn
Jong-Keun
JK
Kim
Myung Ho
MH
Jeong
Jin-Sang
JS
Yoon
D054058:Acute Coronary Syndrome / Q000150:complications*; D000368:Aged; D015283:Citalopram / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D003866:Depressive Disorder / Q000188:drug therapy* / Q000209:etiology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010919:Placebos; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D016896:Treatment Outcome
D015283:Citalopram; D010919:Placebos; D017367:Selective Serotonin Reuptake Inhibitors