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A NEW CLINICAL TRIAL FOR HEART PATIENTS WITH DEPRESSION | |
| Contact: Dr. Matthew M. Burg Phone: 212 342 4491 Email: mb2358@columbia.edu Embargoed until: March 3, 2004 |
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Vancouver, BC, Canada - Depression after a heart attack can lead to future heart attacks and early death. The question is, how best to treat depression soas to improve survival. A new clinical trial to begin answering this question is underway at several sites in the northeast, including Mount Sinai in New York City, and Yale in New Haven, Connecticut. A description of this trial was presented for the first time at the 63rd American Psychosomatic Society Annual Meeting, held March 2-5 in Vancouver, Canada. The trial is part of the Coronary Psychosocial Patient Evaluation Study (COPES), a multi-site, multi-project consortium that is funded by the National Heart, Lung, and Blood Institute. According to Dr. Matthew M. Burg, Principal Investigator of the Yale study site, we know that depression in heart disease patients increases the risk of death after a heart attack, but prior trials of depression treatment for heart patients did not produce any benefit after a heart attack. "These prior trials relied on tested depression treatments" says Dr. Burg, "but they produced only modest reduction in depressive symptoms and no improvement in survival". Among the problems in earlier studies was the reluctance of many patients in the treatment group to cooperate fully with the treatment, and the "spontaneous remission" of depression symptoms among many in the control group. The new trial is smaller in focus than earlier efforts, and is specifically designed to find what type of treatment is most acceptable to patients after a heart attack. "Many patients have symptoms of depression after a heart attack, but they don't identify themselves as having mood problems. Rather, they see their depressed mood as a normal reaction to what they've experienced. This is true for some, but not all patients after heart attack. The important question is to find out who has more real depression, and how to treat them in a way that they will accept", says Dr. Burg. The COPES Trial is a Phase-I, meaning that it is designed to test the acceptability of, and satisfaction with the treatment. To increase acceptability and satisfaction for heart patients, only those with symptoms of depression that persist for 3-months are enrolled. In addition, patients randomized to treatment are given a choice between a brief form of problem-solving psychotherapy and antidepressant medication. Treatment can be augmented, or "stepped-up", but only if depression symptoms do not improve. "By giving patients a choice, and only enrolling those whose symptoms of depression continue for months after their heart attack, we believe patients will respond better. This approach has been found to be very successful with other medical groups who have symptoms of depression, and we are hopeful that cardiac patients will show a similar response", says Dr. Burg. The results of this trial will inform the design of future, large-scale trials that will have the ability to test the effect of treating depression on medical outcomes after heart attack. | |
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Psychosomatic Medicine is the official peer-reviewed journal of the American Psychosomatic Society, published bimonthly. For information about the journal, contact Vicki White, Managing Editor for Manuscript Production,
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