Asthma is common with an increasing prevalence and mortality especially in low-income and
minority populations. The course of asthma appears to be influenced by mood and emotions. It
has been reported that there is a high prevalence of depression or depressive symptoms in
both children and adults with asthma. Despite data on the frequency of depression in asthma
and its adverse consequences, it is generally not recognized or treated. Brown et al.
conducted a randomized, double-blind, placebo-controlled trial of citalopram in 90
outpatients with asthma and MDD. Citalopram therapy was associated with lower depression
scores, numerically greater rates of remission of depressive symptoms, and less oral
corticosteroid use than placebo. The investigators proposed study is different. The
investigators observed a modest difference between antidepressant and placebo in the prior
trial. However, in a subgroup with more severe asthma (based on frequent corticosteroid use)
and more severe depression (based on higher depressive symptoms scores) the investigators saw
a much larger effect size. Standard of care for severe asthma is aggressive asthma treatment.
The investigators study does not require any changes in the patient's asthma treatment. No
guidelines are currently available on the treatment of depression in asthma patients.
Standard care for depression would be antidepressants.