In reply
We appreciate the letter from Drs Rozzini and Trabucci and agree with their call for an antidepressant treatment trial for depressed patients with heart failure. The SADHART trial they cite proves that it is difficult for such trials to show effects on mortality, cardiac events, health care utilization, and costs.1 In this trial, none of the cardiac outcomes and only some of the depression outcomes were significantly different between the treatment groups. The most meaningful antidepressant trial in heart failure patients would need to be a large, well-designed multicenter trial. We welcome inquiries from investigators interested in collaborating in such a trial.
Drs Rozzini and Trabucci's distinction between depression "unmasked" by heart failure vs depression as a marker of "psychic frailty" can be understood as either (1) the difference between reactive vs endogenous depression or (2) the difference between state and trait depression. In either case, we must . . . [Full Text of this Article]
