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To the Editor: In the report of the Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) trial, Dr Lespérance and colleagues¹ conclude that the first step in the treatment of such patients with major depression and coronary artery disease should begin with citalopram or sertraline. While this conclusion seems well founded based on the data from CREATE and those of prior trials, there are some questions related to the generalizability of their findings that must be addressed.

The mean age of patients in CREATE was 58.2 years, which differs considerably from the mean age of patients in the United States with coronary disease. The average age of US patients with a first myocardial infarction is 65.8 years for men and 70.4 years for women.² This is approximately 7.5 and 12 years older than the patients in CREATE, respectively. This is important since age may influence the response to . . . [Full Text of this Article]

Roy C. Ziegelstein, MD
rziegel@jhmi.edu
Department of Medicine
Johns Hopkins University School of Medicine
Baltimore, Md

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