Antidepressant Treatment at an Inner City Asthma Clinic
a 12-week, randomized, double-blind, parallel-group, placebo-controlled acute phase trial of escitalopram is proposed in 222 persons with asthma and MDD. To examine the impact of the antidepressant beyond the 12-week acute phase of treatment we will follow acute phase responders (receiving escitalopram or placebo) for an additional 16 weeks to examine whether additional benefit from the antidepressant occurs with longer treatment.
The participants will be recruited at the PHHS asthma and allergy Clinics and aston Clinic using a two-item screen as part of routine clinical practice. The primary outcome measure will be the asthma Control Questionnaire (aCQ). Remission of depressive symptoms on the 17-item Hamilton Rating Scale for Depression (HRSD17); oral corticosteroid use, self-reported depressive symptoms on the 30-item inventory of Depressive Symptomatology[?]Self-report (iDS-SR30); clinic, eR, and hospital visits the Mini asthma Quality of Life Questionnaire (Mini aQLQ) and Short-Form 36 Health Survey (SF-36) scores will be assessed. Patients will be randomized as follows: 80 participants with baseline scores on the HRSD17 [GreaterThanorequalTo]20 and 3 or more oral corticosteroids in the past 12 months and 142 participants with MDD and asthma but with lower HRSD17 scores ([Less Than]20 but [GreaterThanorequalTo]15) and less than 3 oral corticosteroids in the past 12 months.
* Physician diagnosis of asthma and currently receiving asthma treatment, Current diagnosis of MDD confirmed by the SCID, clinical assessment by a psychiatrist and have seen a physician within the past 6 months
* Baseline HRSD17 >= 15
* Baseline ACQ score of >= 1
* Ages 18-70 years to include the range of ages typically treated at our referral sources
* No changes in asthma medications, oral corticosteroid use, or treatment for respiratory tract infections in the past 2 weeks
* Both male and female
* English- or Spanish-speaking
* Completed week 12 assessment of acute treatment phase
* Acute phase responders (defined as a baseline to week 12 reduction in the HRSD17 score of 50% or greater)