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To The Editor: The report of the CREATE trial by Dr Lespérance and colleagues¹ concluded that citalopram was superior to placebo and found no benefit for interpersonal therapy over clinical management. It is encouraging that the patients in this study responded within 12 weeks to the combination of antidepressant and clinical management, since depression is an independent risk factor for coronary artery disease. We are concerned, however, that readers may dismiss the value of psychotherapy for depression in this population. There are some strong arguments for the use of psychotherapy in conjunction with pharmacotherapy to treat depression.

While uncomplicated psychological issues often do respond well to brief symptom management, major depression is usually accompanied by psychosocial stress. After initial onset, major depression may follow a chronic course² and psychotherapy can prevent reoccurrence,³ presumably by helping patients cope more effectively with stressors related to depression and improving the patient's ability to . . . [Full Text of this Article]

Ellen A. Dornelas, PhD
edornel@harthosp.org
Division of Cardiology
Hartford Hospital
Hartford, Conn

Matthew M. Burg, PhD
Center for Behavioral Cardiovascular Health
Division of General Medicine
Columbia University Medical Center
New York, NY

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Effects of Citalopram and Interpersonal Psychotherapy on Depression in Patients With Coronary Artery Disease: The Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) Trial
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