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

Autor(es)

Fraguas, Renerio ^[1] ; da Silva Telles, Renata Martinho ^[1] ; Toledo Ferraz Alves, Tania Correa ^[1] ; Andrei, Anna Maria ^[2] ; Rays, Jairo ^[2] ; Iosifescu, Dan V. ^[3] ; Wajngarten, Mauricio ^[2]

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Fac Med, Hosp Clin, Dept & Inst Psychiat, BR-05014010 Sao Paulo - Brazil

^[2] Univ Sao Paulo, Fac Med, Clin Hosp, Inst Heart, BR-05014010 Sao Paulo - Brazil

^[3] Harvard Univ, Sch Med, Dept Psychiat, Massachusetts Gen Hosp, Depress Clin & Res Program, Boston, MA 02115 - USA

• Tipo de documento: Artigo Científico
• Fonte: CONTEMPORARY CLINICAL TRIALS; v. 30, n. 3, p. 205-211, MAY 2009.
• Citações Web of Science: 32

Resumo

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. Conclusion: 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. (C) 2009 Elsevier Inc. All rights reserved. (AU)

• Processo FAPESP: 99/04993-5 - Depressao em idosos com insuficiencia cardiaca.
• Beneficiário: Renério Fráguas Junior
• Modalidade de apoio: Auxílio à Pesquisa - Regular