Prophylactic escitalopram reduced the incidence of depression in head and neck cancer (HNC) patients by more than 50% and improved their quality of life, according to a new study in JAMA Otolaryngology — Head & Neck Surgery (June 20, 2013).
Significantly fewer patients taking the antidepressant — a selective serotonin reuptake inhibitor — developed depression when compared with those on placebo (10% versus 24.6%, p = 0.04), according to the study authors, from the University of Nebraska Medical Center in Omaha.
As many as half of HNC patients develop clinical depression within months of their diagnosis, and suicide rates are among the highest in patients with a medical illness, the researchers noted. HNC treatment frequently results in dysphagia, disfigurement, voice alterations, mucositis, need for tracheostomy and feeding tubes, fatigue, and depression.
The randomized, double-blind trial included 148 newly diagnosed HNC 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 (Lexapro) 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.
The researchers found that patients undergoing radiation as their initial therapy were significantly more likely than those who had surgery to develop depression (p = 0.009). In addition, 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 three consecutive months after ending treatment with the antidepressant.
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