A Cochrane review included 16 studies with a total of 4 068 subjects with coronary artery disease and comorbid depressive disorder. Seven trials compared psychological interventions, 8 pharmacological interventions and one trial had a 2x2 factorial design comprising psychological and pharmacological interventions. There was a small beneficial effect of psychological interventions compared to usual care on depression severity and remission rates. Based on one trial per outcome, no beneficial effects on mortality rates, cardiac events, cardiovascular hospitalizations and QoL were found, except for the psychosocial dimension of QoL (small beneficial effect in one trial). Furthermore, no differences on treatment outcomes were found between the varying psychological approaches. There was a small beneficial effect of selective serotonin reuptake inhibitors (SSRIs) compared to placebo on depression outcomes: pooled SMD of short term depression change scores -0.24, 95% CI -0.38 to -0.09 (3 studies, n=707); pooled OR of short term depression remission 1.80, 95% CI 1.18 to 2.74 (3 studies, n=429). Based on one to three trials per outcome, no beneficial effects regarding mortality, cardiac events and QoL were found. Hospitalization rates (OR 0.58, 95% CI 0.39 to 0.85; 3 studies, n=514) and emergency room visits (OR 0.58, 95% CI 0.34 to 1.00; 1 study, n=369) were reduced in trials of pharmacological interventions compared to placebo. No evidence of a superior effect of paroxetine (SSRI) versus nortriptyline (tricyclic antidepressants) regarding depression outcomes was found in one trial.
Comment: The quality of evidence is downgraded by study limitations (selective outcome reporting) and by imprecise results (few patients for each comparison).