• Symptoms of depression in congestive heart failure patients with clinical depression after treatment with sertraline or placebo [ Time Frame: Measured at Week 12 ] [ Designated as safety issue: No ]
  

• Reduction in cardiac events and morbidity / mortality, including rehospitalization, in congestive heart failure patients with depression after treatment with sertraline or placebo [ Time Frame: Measured at Week 12 ] [ Designated as safety issue: No ]
  

Comorbid depression in people with chronic medical illness is a serious public health concern. Depressive disorders lead to increased morbidity, mortality, and poorer outcomes in ischemic heart disease, a leading cause of chronic heart failure (CHF). Evidence suggests that a relationship exists between depression and CHF; studies that examine the way CHF is affected by depression treatments are needed.

Participants in this study will be randomly assigned to receive either sertraline or placebo for 12 weeks. Assessments will be made at Weeks 2, 4, 6, 8, 10, and 12. Participants who do not respond to their treatment will have their medication dose adjusted following assessment. Interviews and rating scales will be used to assess depressive symptoms, cognitive status, psychiatric comorbidity, daily and chronic stress, and social support. A follow-up visit will take place 6 months, 1 year, 2 years, and 3 years after study completion.

Inclusion Criteria:

• Chronic heart failure
• DSM-IV criteria for major depression
• Current use of any antipsychotic medication at study entry

Exclusion Criteria:

• Life-threatening comorbidity with a 50% or higher likelihood of death within 1 year
• History of psychoses, bipolar disorder, or severe personality disorder
• History of alcohol or drug dependence in the last year
• Severe physical disability that may interfere with the study
• Neurological impairment
• Active suicidal ideations
• Current use of antidepressant medication(s) at the start of study medication