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Medication may prevent depression in patients with head and neck cancer

Taking the antidepressant citalopram before beginning treatment for head and neck cancer may help prevent depression during therapy, according to results of a pilot study published in the May issue of Archives of OtolaryngologyHead & Neck Surgery, one of the JAMA/Archives journals.

Treatment for head and neck cancer can be arduous and debilitating, the authors write as background information in the article. 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.

William M. Lydiatt, M.D., of the University of Nebraska Medical Center and Nebraska Methodist Hospital, Omaha, and colleagues conducted a randomized clinical trial involving patients with head and neck cancer. Before beginning treatment, 15 participants were randomly assigned to receive 40 milligrams of the antidepressant citalopram daily and 13 were randomly assigned to take placebo. The patients took the medications for 12 weeks, during which time they underwent cancer treatment and were screened for depression every four weeks. Twenty-two patients were assessed at week 12, and 23 patients completed a final study visit four weeks after stopping the medication.

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, the authors write. No patients in the citalopram group became suicidal, compared with two in the placebo group. Quality of life, as measured by a self-administered questionnaire, deteriorated in both groups during treatment but less so in the group taking citalopram.

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, the authors conclude. This study suggests a tangible means to improve outcome in patients with head and neck cancer and supports additional research toward this aim.


Contact: Vicky Cerino
JAMA and Archives Journals

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