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May 2, 2007

Treatment of Depression in Patients With Coronary Artery Disease—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2007;297(17):1878-1880. doi:10.1001/jama.297.17.1880-a

In Reply: Dr Ziegelstein raises the issue of the representativeness of the CREATE study population and cites statistics for the mean age at time of first myocardial infarction in US patients to support his argument. The CREATE sample was not restricted to patients with a history of myocardial infarction. It also included patients who had angioplasty, coronary artery bypass graft surgery, or cardiac catheterization results showing a greater than 50% blockage in at least 1 major coronary artery. All CREATE patients were seeking outpatient treatment for major depression. Although it has been reported that elderly patients are underrepresented in trials of acute coronary syndromes,1 there were no age limits on the CREATE sample. It has also been suggested that elderly individuals are less likely to seek treatment for major depression than younger patients.2 While we agree that age may be an important variable in considering lack of treatment response and cite several trials illustrating the difficulty of treating depression in the elderly population, we do not agree that elderly patients respond better with the combination of psychotherapy and medication. The most recently published study of maintenance therapy for major depression in elderly patients evaluated an SSRI combined with either clinical management or interpersonal psychotherapy.3 As in the CREATE trial, there was no added benefit to interpersonal psychotherapy over clinical management for either the SSRI or placebo groups.

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