Antidepressant may help head/neck cancer patients

The results of a pilot study suggest that antidepressant therapy with Celexa during treatment for head and neck cancer reduces the risk of depression and diminishes the impact of cancer treatment on quality of life.

Depression has been reported in up to 40 percent of patients with head and neck cancer "typically within the first 3 months of diagnosis," Dr. William M. Lydiatt and colleagues write in the journal, Archives of Otolaryngology - Head and Neck Surgery.

The elevated suicide rates associated with cancer are particularly high among patients with head and neck cancer, Lydiatt told Reuters Health. "The relative intensity of treatment, and the fact that treatments tend to affect the most basic aspects of living, including speech, swallowing, and breathing" contribute to the increased rates of depression and suicide in head and neck cancer patients, he explained.

Because most of the treatment for head and neck cancer - surgery and radiation - is completed in 12 weeks, Lydiatt's team conducted their pilot study during 12 weeks of treatment, with a final 16-week follow-up visit.

The research team, based at the University of Nebraska Medical Center in Omaha, randomly assigned 36 patients to Celexa (also called citalopram) or to matching placebo. Thirteen patients in the Celexa group and 10 in the placebo group completed the trial.

"All measures of psychiatric well-being favored the group taking citalopram," Lydiatt and his colleagues report.

Fifteen percent of patients taking Celexa had symptoms of depression that were at least "mild" at week 16, whereas 60 percent in the placebo group were rated "mildly ill" or worse.

Similarly, the percentage diagnosed with major depression was 17 percent in the Celexa group compared with 50 percent at weeks 12 and 16 in the placebo group.

In the placebo group two patients experienced suicidal thoughts and one patient was hospitalized for depression, compared with none in the Celexa group.

Quality of life declined in both groups, but less so in the antidepressant group, and while quality of life continued to worsen between 12 and 16 weeks in the placebo group, it actually improved in the Celexa group.

"These findings are hopeful, but this study was too small for us to make a definitive recommendation to treat all head and neck cancer patients with antidepressants," Lydiatt noted.

"We have started a similar trial in a larger group of patients, with funding by the National Institutes of Mental Health, to study this issue more completely using the antidepressant escitalopram, also known as Lexapro."

SOURCE: Archives of Otolaryngology Head and Neck Surgery, May 2008.