People with heart disease and depression showed improvements in their symptoms after taking an antidepressant but counselling did not seem to show the same benefits, Canadian researchers have found.

Studies show the prevalence of depression among patients hospitalized for heart disease ranges between 17 per cent and 27 per cent.

Treating the condition may help to slow deterioration in health, some doctors believe. It's thought that stress hormones released during depression may constrict blood vessels and lead to blockage in the arteries.

To test the treatment idea, Dr. François Lespérance, a psychiatrist at the University of Montreal, and his colleagues randomly assigned 284 patients with coronary artery disease to take 12 weeks of:

• Sessions including interpersonal psychotherapy plus clinical management, or clinical management only, and
• An antidepressant drug or a placebo.

The drug given was citalopram, an SSRI type of antidepressant, the researchers said in Tuesday's issue of the Journal of the American Medical Association.

The drug seemed to help the most common symptoms of depression the most compared to a placebo, the researchers found.

"Citalopram or sertraline, as previously shown in [a different trial], plus clinical management should be considered for the initial acute-phase treatment for major depression in patients with [coronary artery disease]," the study's authors concluded.

"It remains to be demonstrated that any form of psychotherapy is superior to clinical management in reducing depression symptoms in this group."

Those in the psychotherapy group participated in sessions on dealing with interpersonal conflicts, life transitions, grief and loss, problems that are common among heart disease patients.

Clinical management involved weekly sessions on depression and medication, and encouragement to take medication as prescribed.

All of the patients had previously had a heart attack or major clogged arteries and met criteria for major depression lasting at least four weeks.

The findings offer more evidence that SSRIs fight depression in people with heart disease, Dr. Alexander Glassman and Dr. J. Thomas Bigger of the New York State Psychiatric Institute said in an editorial in the same issue.

A larger study is needed to show if taking the drugs also helps to reduce the risk of a second heart attack, research the pair said is "urgently needed."

The research was supported by the Canadian Institutes of Health Research, the Fondation du Centre Hospitalier de l'Université de Montréal, and the Fondation de l'Institut de Cardiologie de Montréal. Citalopram and matching placebo were donated by Lundbeck Canada Inc.