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Implementing an antidepressant treatment strategy for post-MI depression does not reduce risk of further cardiovascular events or mortality

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Question: Does antidepressant treatment of postmyocardial infarction (MI) depression reduce risk of further cardiovascular events or mortality compared with usual care?

Patients: In total, 331 adults diagnosed with International Classification of Diseases 10th Edition (ICD-10) depression between 3 and 12 months post-MI. Initial screening was through the use of Beck Depression Inventory administered at baseline, 3, 6, 9 and 12 months post-MI. Exclusions: current treatment of depression; other diseases likely to influence long-term survival; communication difficulties or inability to participate in follow-up. Both arms had similar demographics, depressive symptom severity and cardiovascular disease severity and risk factors.

Setting: Eleven hospitals in the Netherlands.

Intervention: Active antidepressant treatment versus usual care. Participants randomised to receive active treatment were given three options: double-blind placebo-controlled trial of mirtazepine followed by open treatment with citalopram if there was insufficient response after 8 weeks; open treatment with citalopram; or ‘tailored treatment’ at the psychiatrist's discretion. Treatment duration was 6 months …

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