Comparison of Depression Interventions after Acute Coronary Syndrome (CODIACS) is a multi-center feasibility/vanguard study to assess the feasibility and estimate the effectiveness of an enhanced care intervention relative to standard care for depressive symptoms in 150 persistently depressed (2-months) post-ACS patients. It is funded by the National Heart, Lung, and Blood Institute and is jointly coordinated by the University of North Carolina at Chapel Hill and Columbia University.
Patients with an acute coronary syndrome (ACS) and comorbid depressive symptoms will be recruited from a network of hospitals connected with five field centers (Columbia University, Washington University, University of Pennsylvania, Emory University, and Yale University). The stepped care (SC) intervention involves offering patients the choice of receiving psychotherapy and/or antidepressant treatment, and a stepped algorithm in which treatment is adjusted as needed according to predetermined decision rules. Referred care (RC) involves physician notification of depression and subsequent treatment as determined by the patientís physician. The intervention will be 6 months, and measures of depression and major cardiac events or death will be collected over a 6-month period after randomization.