According to a study published in the May issue of Archives of Otolaryngology-Head and Neck Surgery, patients may be able to prevent depression during therapy if they begin a regimen of the antidepressant citalopram prior to beginning head and neck cancer (HNC) treatment.
Providing background information, the authors note that, “Treatment for head and neck cancer can be arduous and debilitating.” They add that, “Psychiatric morbidity in these patients is frequent and underdiagnosed. Major depressive disorder has been reported in up to 40 percent of patients with head and neck cancer, typically within the first three months of diagnosis.”
To determine the link between treatment with the antidepressant citalopram hydrobromide and major depressive disorder in patients undergoing therapy for HNC, William M. Lydiatt, M.D. (University of Nebraska Medical Center and Nebraska Methodist Hospital, Omaha) and colleagues conducted a randomized clinical trial. During randomization, 15 participants were placed in a group that received 40 milligrams per day of the antidepressant citalopram and 13 were assigned to take placebo. During the 12 weeks that the patients took these medications, they underwent HNC treatment; every four weeks, the patients received a depression screening. After 12 weeks, 22 patients were assessed. Four weeks after stopping the medication, 23 patients finished a final study visit.
The researchers found that, “The numbers of subjects who met predefined cutoff criteria for depression during the 12 weeks of active study were five of 10 (50 percent) taking placebo and two of 12 (17 percent) taking citalopram.” Two of the patients in the placebo group became suicidal, but none did in the citalopram group. A self-administered questionnaire used to measure quality of life indicated that quality decreased during treatment in both groups, but less so in the citalopram group.
“The data from this pilot trial suggest that prevention of major depressive disorder in patients undergoing treatment for head and neck cancer may be an attainable goal. The data show trends toward major depressive disorder prevention in this small sample. All measures of psychiatric well-being favored the group taking citalopram,” conclude the authors. “This study suggests a tangible means to improve outcome in patients with head and neck cancer and supports additional research toward this aim.”
A Randomized, Placebo-Controlled Trial of Citalopram for the Prevention of Major Depression During Treatment for Head and Neck Cancer
William M. Lydiatt, MD; David Denman, MD; Dennis P. McNeilly, PsyD; Susan E. Puumula, MS; William J. Burke, MD
Archives of Otolaryngology-Head & Neck Surgery (2008). 134[5]:528-535.
Written by: Peter M Crosta