In the January 2012 issue of the Journal of Psychosomatic Research, Hansen et al. reported results from the DEpression in patients with Coronary ARtery Disease (DECARD) trial. DECARD was designed to test the hypothesis that treating patients who are not depressed with the antidepressant escitalopram for 1year after an acute coronary syndrome (ACS) would reduce the number of patients who develop depression. Patients were randomized within 8weeks of the ACS to receive escitalopram (n=120) or placebo (n=119) and were assessed 9 times over the course of the 12-month study period. The authors reported that 2 patients treated with escitalopram developed depression versus 10 in the placebo group and concluded that escitalopram prevented depression in post-ACS patients. The way in which this trial was designed, conducted, and reported, however, raises questions about whether these findings could be reproduced in an adequately powered trial and suggests that considerable caution should be used in their interpretation. More generally, the appropriateness of exposing ACS patients without depression to antidepressants must be questioned, even if one were to accept these findings.