Background:

Depression is highly prevalent in patients following coronary artery bypass graft (CABG) surgery and negatively affects recovery and prognosis. Selecting an appropriate antidepressant in this cardiac population remains a clinical challenge.

Objective:

This study aimed to compare the efficacy and safety of bupropion versus escitalopram in the treatment of major depressive disorder (MDD) in post-CABG patients. Both medication have limited cardiac side effects and drug intraction.

Methods:

In a double-blind, randomized controlled trial, 100 patients diagnosed with post-CABG depression based on DSM-5 criteria were assigned to receive either bupropion (150–300 mg/day) or escitalopram (10–20 mg/day) for 8 weeks. Depression severity was assessed using the Hamilton Depression Rating Scale (HAM-D) and the Beck Depression Inventory-II (BDI-II) at baseline, and after 2, 4, and 8 weeks of treatment. Primary outcome was change in HAM-D score; secondary outcome was change in BDI-II.

Results:

Both groups demonstrated significant improvements in depression scores over time. At week 8, mean HAM-D scores decreased from 15.8 to 8.1 in the bupropion group and from 16.3 to 7.8 in the escitalopram group (p > 0.05). Similar patterns were observed in BDI-II scores. No serious adverse events were reported.

Conclusion:

Following cardiac surgery, the risk of developing symptoms of depression and anxiety is high. Identifying and determining of suitable medication with low cardiac vascular side effects and interaction is helpful in clinical decision making for physician. Both tracs were equally effective and well-tolerated in treating post-CABG depression. The findings support flexible antidepressant selection based on individual patient profiles.