Prophylactic escitalopram cut the incidence of depression in head and neck cancer patients by more than 50% and improved quality of life, a clinical trial showed.
Significantly fewer patients taking the antidepressant developed depression, when compared with those on placebo (10% vs 24.6%; stratified log-rank test, P=.04), according to a study in the June 20 issue of JAMA Otolaryngology Head and Neck Surgery.
“Depression is very common among patients with this disease, but it is not easy to predict who will become depressed at the beginning of treatment,” University of Nebraska Medical Center professor of head and neck oncology William Lydiatt, MD, told MedPage Today. “That’s why the prevention paradigm may offer considerable benefit at an acceptable risk.”
As many as half of head and neck cancer patients develop clinical depression within months of their diagnosis and suicide rates are among the highest in patients with a medical illness, Lydiatt noted.
“The burden of treatment is extensive and frequently includes dysphagia, disfigurement, voice alterations, mucositis, need for tracheostomy and feeding tubes, fatigue and depression,” the researchers wrote.
They chose the generic version of the popular SSRI Lexapro for the trial to give patients an affordable treatment option that’s well tolerated in the elderly.
The randomized, double-blind trial included 148 newly diagnosed head and neck cancer patients entering treatment who did not yet have a diagnosis of depression. The patients were stratified by sex, site of disease, stage, and primary modality of treatment (surgery versus radiation).
Half were treated with escitalopram at a dosage of 10 mg/d for the first week (one tablet) followed by 20 mg/d (two tablets) until week 16, followed by an additional week of 10 mg/d. During the acute phase of the study, dosage was reduced to 10 mg/d when adverse events occurred. Patients not treated with the antidepressant received matching placebo pills.
Among the study’s major findings:
- Patients undergoing radiation as their initial therapy were significantly more likely than those who had surgery to develop depression (hazard ratio, 3.6; 95% CI ,1.38-9.40; P=.009).
- A Cox progression hazards regression model comparing the two groups, after controlling for age, smoking status, and other variables, demonstrated an advantage for escitalopram (hazard ratio, 0.37; 95% CI, 0.14-0.96: P=.04).
- Patients who took escitalopram and who completed the study without developing depression rated their overall quality of life as significantly better than those in the placebo group for 3 consecutive months after ending treatment with the antidepressant (overall quality of life, good or outstanding at weeks 20, 24 and 28 – escitalopram group = 96%, 100%, 96%, respectively; placebo group = 77%, 86%, 85%).
Lydiatt said the finding that radiotherapy patients had a higher risk for depression than surgery patients is a big surprise with important potential clinical implications.
“The higher incidence of depression in the cohort receiving radiation suggests that radiation represents a greater and longer duration stress event than surgery,” the researchers wrote. “Radiation may also generate greater inflammatory cytokines during treatment, which could contribute to the higher rate (of depression).”
Although overall treatment success and survival were not study endpoints, Lydiatt said he hopes to conduct further research with these outcomes in mind.
“I would not be surprised to see a survival advantage associated with this approach,” he said. “Depression is associated with so many negative manifestations in these patients. Depressed patients don’t comply with their treatments to the same degree as patients who aren’t depressed and they don’t take care of themselves as well. They often lose their spark to live.
*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.