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Original Research

Escitalopram Treatment for Depressive Disorder Following Acute Coronary Syndrome: A 24-Week Double-Blind, Placebo-Controlled Trial

Jae-Min Kim, MD, PhD; Kyung-Yeol Bae, MD, PhD; Robert Stewart, MD, MRCPsych; Bo-Ok Jung, MD, MSc; Hee-Ju Kang, MD, MSc; Sung-Wan Kim, MD, PhD; Il-Seon Shin, MD, PhD; Young Joon Hong, MD, PhD; Ju Han Kim, MD, PhD; Hee-Young Shin, MD, PhD; Gaeun Kang, MD, MSc; Youngkeun Ahn, MD, PhD; Jong-Keun Kim, MD, PhD; Myung Ho Jeong, MD, PhD; and Jin-Sang Yoon, MD, PhD

Published: October 14, 2014

Article Abstract

Objective: Depression is common after acute coronary syndrome (ACS) and has adverse effects on prognosis. There are few evidence-based interventions for treating depression in ACS. This study investigated the efficacy and safety of escitalopram in treating depressive disorders identified 2-14 weeks after a confirmed ACS episode.

Method: A total of 217 patients with DSM-IV depressive disorders (121 major and 96 minor) and ACS were randomly assigned to receive escitalopram in flexible doses of 5-20 mg/d (n = 108) or placebo (n = 109) for 24 weeks. The study was conducted from 2007 to 2013. The primary outcome measure was the Hamilton Depression Rating Scale (HDRS). Secondary outcome measures included the Montgomery-Asberg Depression Rating Scale (MADRS), Beck Depression Inventory (BDI), Clinical Global Impressions-Severity of Illness scale (CGI-S), Social and Occupational Functioning Assessment Scale (SOFAS), and World Health Organization Disability Assessment Schedule-12. Cardiovascular safety outcomes included echocardiography, electrocardiography, laboratory test, body weight, and blood pressure results.

Results: Escitalopram was superior to placebo in reducing HDRS scores (mean difference = 2.3, P = .016, effect size = 0.38). Escitalopram was also superior to placebo in decreasing depressive symptoms evaluated by the MADRS, BDI, and CGI-S and in improving SOFAS functioning level. Escitalopram was not associated with any harmful changes in cardiovascular safety measures. Dizziness was significantly more frequently reported in the escitalopram group (P = .018), but there were no significant differences in any other adverse events.

Conclusions: These results indicate that escitalopram has clinically meaningful antidepressant effects with no evidence of reduced cardiovascular safety in depressive disorder following ACS.

Trial Registration: identifier: NCT00419471

Volume: 76

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