***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: CONTEXT Depression and low perceived social support ( LPSS ) after myocardial infa rct ion ( MI ) are associated with higher morbidity and mortality , but little is known about whether this excess risk can be reduced through treatment . OBJECTIVE To determine whether mortality and recurrent infa rct ion are reduced by treatment of depression and LPSS with cognitive behavior therapy ( CBT ) , supplemented with a selective serotonin reuptake inhibitor ( SSRI ) antidepressant when indicated , in patients enrolled within 28 days after MI . DESIGN , SETTING , AND PATIENTS R and omized clinical trial conducted from October 1996 to April 2001 in 2481 MI patients ( 1084 women , 1397 men ) enrolled from 8 clinical centers . Major or minor depression was diagnosed by modified Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition criteria and severity by the 17-item Hamilton Rating Scale for Depression ( HRSD ) ; LPSS was determined by the Enhancing Recovery in Coronary Heart Disease Patients ( ENRICHD ) Social Support Instrument ( ESSI ) . R and om allocation was to usual medical care or CBT-based psychosocial intervention . INTERVENTION Cognitive behavior therapy was initiated at a median of 17 days after the index MI for a median of 11 individual sessions throughout 6 months , plus group therapy when feasible , with SSRIs for patients scoring higher than 24 on the HRSD or having a less than 50 % reduction in Beck Depression Inventory scores after 5 weeks . MAIN OUTCOME MEASURES Composite primary end point of death or recurrent MI ; secondary outcomes included change in HRSD ( for depression ) or ESSI scores ( for LPSS ) at 6 months . RESULTS Improvement in psychosocial outcomes at 6 months favored treatment : mean ( SD ) change in HRSD score , -10.1 ( 7.8 ) in the depression and psychosocial intervention group vs -8.4 ( 7.7 ) in the depression and usual care group ( P<.001 ) ; mean ( SD ) change in ESSI score , 5.1 ( 5.9 ) in the LPSS and psychosocial intervention group vs 3.4 ( 6.0 ) in the LPSS and usual care group ( P<.001 ) . After an average follow-up of 29 months , there was no significant difference in event-free survival between usual care ( 75.9 % ) and psychosocial intervention ( 75.8 % ) . There were also no differences in survival between the psychosocial intervention and usual care arms in any of the 3 psychosocial risk groups ( depression , LPSS , and depression and LPSS patients ) . CONCLUSIONS The intervention did not increase event-free survival . The intervention improved depression and social isolation , although the relative improvement in the psychosocial intervention group compared with the usual care group was less than expected due to substantial improvement in usual care patients Objective : The National Heart , Lung , and Blood Institute convened an interdisciplinary working group of experts to develop recommendations for the assessment and treatment of depression in patients with coronary heart disease ( CHD ) . Method : Consensus of experts . Results : Our current recommendations are that the Beck Depression Inventory-I be employed for epidemiological studies of depression and CHD , that the Patient Health Question naire 2-item version be employed for screening for trial eligibility , that the Depression Interview and Structured Hamilton ( DISH ) be employed for diagnostic ascertainment for trial inclusion , and that the Hamilton rating scale , which is part of the DISH , be employed for both depression symptom reduction and the remission criterion in any trial . We further recommend that a r and omized controlled trial be undertaken to determine whether selective serotonin reuptake inhibitors , psychotherapy , or combined treatment can reduce the risk of CHD events and mortality associated with depression in CHD patients . Conclusions : This report summarizes the recommendations made by the working group and discusses the rationale for each recommendation , the strengths and weaknesses of alternative approaches to assessment and treatment , and the implication s for future research in this area . ACS = acute coronary syndrome ; BDI = Beck Depression Inventory ; CBASP = Cognitive Behavioral Analysis System of Psychotherapy ; CBT = cognitive behavior therapy ; CIDI = Composite International Diagnostic Interview ; CHD = coronary heart disease ; CVD = cardiovascular disease ; DISH = Depression Interview and Structured Hamilton ; ENRICHD = Enhancing Recovery in Coronary Heart Disease ; HAM-D = Hamilton Rating Scale for Depression ; IDS-SR = Inventory of Depressive Symptomatology , self-report ; IMPACT = Improving Mood – Promoting Access to Collaborative Treatment ; IPT = interpersonal therapy ; MI = myocardial infa rct ion ; NHLBI = National Heart , Lung , and Blood Institute ; PHQ = Patient Health Question naire ; RCT = r and omized controlled trial ; SADHART = Sertraline Antidepressant Heart Attack R and omized Trial ; SCID = Structured Clinical Interview for DSM-IV ; SSRI = selective serotonin reuptake inhibitor ; STAR*D = Sequenced Treatment Alternatives to Relieve Depression OBJECTIVE The reporting of depressive symptoms following myocardial infa rct ion may be confounded by complaints originating from the myocardial infa rct ion . Therefore , it is difficult to estimate the effects of post-myocardial infa rct ion depression and its treatment on cardiovascular prognosis . The authors ' goal was to study the relationship between depressive symptom dimensions following myocardial infa rct ion and both somatic health status and prospect i ve cardiovascular prognosis . METHOD In two studies of myocardial infa rct ion patients ( N=494 and 1,972 ) , the Beck Depression Inventory was used to determine the dimensional structure of depressive symptoms following myocardial infa rct ion . Three symptom dimensions-somatic/affective , cognitive/affective , and appetitive-were compared with baseline left ventricular ejection fraction , Charlson comorbidity index , Killip class , and previous myocardial infa rct ion . The relationship between depressive symptom dimensions and prospect i ve cardiovascular mortality and cardiac-related readmissions was also examined ( mean follow-up duration = 2.5 years ) . RESULTS Somatic/affective symptoms were associated with poor health status ( left ventricular ejection fraction , Charlson comorbidity index , Killip class , and previous myocardial infa rct ion ) and predicted cardiovascular mortality and cardiac events . Cognitive/affective symptoms were only marginally associated with somatic health status and not with cardiovascular death and cardiac events . Appetitive symptoms were related to somatic health status but did not predict cardiovascular death or cardiac events . CONCLUSIONS Somatic/affective depressive symptoms following myocardial infa rct ion were confounded by somatic health status yet were prospect ively associated with cardiac prognosis even after somatic health status was controlled . Cognitive/affective depressive symptoms were only marginally related to health status and not to cardiac prognosis . These findings suggest that treatment of depression following myocardial infa rct ion might improve cardiovascular prognosis when it reduces somatic/affective symptoms Objective : To examine the antidepressant efficacy of a dual-acting antidepressant ( mirtazapine ) in patients with post-myocardial infa rct ion ( MI ) depressive disorder . Antidepressants used in post MI trials with a r and omized , double-blind , placebo-controlled design have been restricted to selective serotonin reuptake inhibitors ( SSRIs ) . Antidepressant effects have been limited . Methods : In a prospect i ve multicenter study , 2177 patients with MI were evaluated for depressive disorder during the first year post MI . Ninety-one patients who met the Diagnostic and Statistical Manual of Mental Disorders , 4th Edition ( DSM-IV ) criteria for major or minor depressive disorder were r and omized to a 24-week , double-blind , placebo-controlled trial . Antidepressant efficacy was tested using last-observation-carried-forward procedure and repeated measurements analysis using the SPPS mixed models approach , with as primary outcome reduction in depressive symptomatology on the 17-item Hamilton-Depression Rating Scale ( Ham-D ) , and secondary outcomes the Beck Depression Inventory ( BDI ) and depression subscale of the Symptom Check List 90 items ( dSCL-90 ) as well as the Clinical Global Impression ( CGI ) scale . Results : Using the “ last observation carried forward ” ( LOCF ) method , mirtazapine did not show to be superior to placebo on the Ham-D , but did on the BDI , dSCL-90 , and CGI scale over the acute treatment phase of 8 weeks ( n = 91 ) . Using mixed models analysis over the entire 24 weeks of treatment ( n = 40 ) , we did find a significant difference favoring mirtazapine to placebo on the Ham-D , BDI , and CGI , but on the dSCL-90 , this difference was not significant . Conclusions : This trial shows efficacy of mirtazapine on primary and secondary depression measures . Mirtazapine seems to be safe in the treatment of post-MI depression . MI = myocardial infa rct ion ; RCT = r and omized controlled trial ; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders ; CAD = coronary artery disease ; SSRI = selective serotonin reuptake inhibitors ; TCA = tricyclic antidepressant ; Ham-D = Hamilton-Depression Rating Scale ; BDI = Beck Depression Inventory ; CGI = Clinical Global Impression ; dSCL-90 = Symptom Check List 90 items , depression subscale ; SES = st and ardized effect size OBJECTIVE To determine the validity of a two- question case-finding instrument for depression as compared with six previously vali date d instruments . DESIGN The test characteristics of a two- question case-finding instrument that asks about depressed mood and anhedonia were compared with six common case-finding instruments , using the Quick Diagnostic Interview Schedule as a criterion st and ard for the diagnosis of major depression . SETTING Urgent care clinic at the San Francisco Department of Veterans Affairs Medical Center . PARTICIPANTS Five hundred thirty-six consecutive adult patients without mania or schizophrenia . MEASUREMENTS AND MAIN RESULTS Measurements were two questions from the Primary Care Evaluation of Mental Disorders patient question naire , both the long and short forms of the Center for Epidemiologic Studies Depression Scale , both the long and short forms of the  Book Depression Inventory , the Symptom-Driven Diagnostic System for Primary Care , the Medical Outcomes Study depression measure , and the Quick Diagnostic Interview Schedule . The prevalence of depression , as determined by the st and ardized interview , was 18 % ( 97 of 536 ) . Overall , the case-finding instruments had sensitivities of 89 % to 96 % and specificities of 51 % to 72 % for diagnosing major depression . A positive response to the two-item instrument had a sensitivity of 96 % ( 95 % confidence interval [ CI ] , 90 - 99 % ) and a specificity of 57 % ( 95 % CI 53 - 62 % ) . Areas under the receiver operating characteristic curves were similar for all of the instruments , with a range of 0.82 to 0.89 . CONCLUSIONS The two- question case-finding instrument is a useful measure for detecting depression in primary care . It has similar test characteristics to other case-finding instruments and is less time-consuming CONTEXT Few r and omized controlled trials have evaluated the efficacy of treatments for major depression in patients with coronary artery disease ( CAD ) . None have simultaneously evaluated an antidepressant and short-term psychotherapy . OBJECTIVE To document the short-term efficacy of a selective serotonin reuptake inhibitor ( citalopram ) and interpersonal psychotherapy ( IPT ) in reducing depressive symptoms in patients with CAD and major depression . DESIGN , SETTING , AND PARTICIPANTS The Canadian Cardiac R and omized Evaluation of Antidepressant and Psychotherapy Efficacy , a r and omized , controlled , 12-week , parallel-group , 2 x 2 factorial trial conducted May 1 , 2002 , to March 20 , 2006 , among 284 patients with CAD from 9 Canadian academic centers . All patients met Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition criteria for diagnosis of major depression of 4 weeks ' duration or longer and had baseline 24-item Hamilton Depression Rating Scale ( HAM-D ) scores of 20 or higher . INTERVENTIONS Participants underwent 2 separate r and omizations : ( 1 ) to receive 12 weekly sessions of IPT plus clinical management ( n = 142 ) or clinical management only ( n = 142 ) and ( 2 ) to receive 12 weeks of citalopram , 20 to 40 mg/d ( n = 142 ) , or matching placebo ( n = 142 ) . MAIN OUTCOME MEASURES The primary outcome measure was change between baseline and 12 weeks on the 24-item HAM-D , administered blindly during central ized telephone interviews ( tested at alpha = .033 ) ; the secondary outcome measure was self-reported Beck Depression Inventory II ( BDI-II ) score ( tested at alpha = .017 ) . RESULTS Citalopram was superior to placebo in reducing 12-week HAM-D scores ( 
    Output:
    
There was no evidence that depression treatment improved cardiac outcomes .
Depression treatment with medication or cognitive behavioral therapy in patients with cardiovascular disease is associated with modest improvement in depressive symptoms but no improvement in cardiac outcomes .
No clinical trials have assessed whether screening for depression improves depressive symptoms or cardiac outcomes in patients with cardiovascular disease