Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacity (CREATE) Study Delivers Surprising Results
Jan 25, 2007 - 8:51:12 PM

Nearly twenty percent of cardiac patients suffer from major depression, which may have a significant negative impact on the outcome of the cardiac disease. A Canada-wide study directed by Dr. François Lespérance, professor of psychiatry at the Université de Montréal and head of the Department of Psychiatry at the Centre hospitalier de l’Université de Montréal (CHUM) is the first to assess the value of two treatments available to these patients: SSRI antidepressants and interpersonal psychotherapy. The results, to be published tomorrow in the Journal of the American Medical Association, demonstrate the effectiveness of antidepressants, while showing that psychotherapy has little benefit for depressed heart patients.

“Initially, our results seemed surprising and even disappointing,” Dr. Lespérance reports. “We had expected to find that psychotherapy would have a positive effect. After validation and careful analysis of the data, we could see that psychotherapy was no better than regular clinical control visits in improving depressive symptoms in these patients, but that citalopram, an SSRI antidepressant, was significantly more beneficial than placebo.”

The study’s co-author, Nancy Frasure-Smith, a professor in McGill University’s Department of Psychiatry and researcher at the CHUM and the Montreal Heart Institute, notes that the innovative study is one of the first to evaluate the treatment of major depression in patients with a physical illness. “There have been few studies on how to treat such patients, yet it is clear that physical and mental health influence each other.”

The study, entitled CREATE (Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacity) was funded by the Canadian Institutes of Health Research (CIHR), an independent public agency of the Canadian government, and by the CHUM and Montreal Heart Institute foundations. The study followed 284 coronary heart disease patients who also met the diagnostic criteria for major depression.

All subjects met weekly with a health care professional for an assessment of their condition. Half were chosen at random to receive the SSRI antidepressant citalopram, and half received a placebo. Half of the patients in each of these two groups were also selected at random to take part in to interpersonal psychotherapy, with the others having only the weekly control visits. The psychotherapy sessions were given by psychologists, social workers, and occupational therapists specially trained in interpersonal psychotherapy.

“Regular follow-up by a health care professional had a positive impact on the participants’ condition,” Dr. Lespérance concludes. “In fact, the twenty-minute follow-up visits proved to be just as beneficial as the psychotherapy sessions or even more so.”

“The results of Dr. Lesperance’s team demonstrate the importance of studying mental health problems for people afflicted with a physical disease, ” explains Dr. Rémi Quirion, scientific director of the CIHR Institute of Neurosciences, Mental Health and Addiction. “This project illustrates the importance of adequately funding health research and more specifically research into mental health.”

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