Lydiatt, W.M., Denman, D., McNeilly, D.P., Puumula, S.E., & Burke, W.J. (2008). A randomized, placebo-controlled trial of citalopram for the prevention of major depression during treatment for head and neck cancer. Archives of Otolaryngology, 134, 528–535.doi:10.1001/archotol.134.5.528
To determine whether prophylactic treatment with the antidepressant citalopram hydrobromide can prevent major depression in patients undergoing treatment for head and neck cancer
The intervention consisted of 40 mg citalopram hydrobromide (a selective serotonin reuptake inhibitor). Medication began with 20 mg/day for week 1 and increased to 40 mg/day until week 12; after week 12, the dosage decreased to 20 mg/day for one week and then the drug therapy was stopped. Data were collected at baseline and at weeks 4, 8, 12, and 16 as well as at any time during the study.
Prospective, randomized, placebo-controlled trial with double blinding
During the 12 weeks of the study, 5 out of 10 taking the placebo and 2 out of 12 taking citalopram met the cutoff criteria for depression (measured by HRSD). However, the difference was statistically insignificant (Fisher exact test, p = 0.17). At the end of the study, of those receiving citalopram 15% were at least mildly ill in terms of global mood state as measured by the CGI-S scale; 60% of those in the control group were at least mildly ill as measured by the same means. Quality of life, measured by the UW-QOL, deteriorated in both groups from baseline to week 16, but less deterioration occurred in the citalopram group (p = 0.14).
Prophylactic treatment with citalopram hydrobromide may decrease the incidence and severity of depression during head and neck cancer therapy.
The risk of major depressive disorder can be very high in patients with head and neck cancer who are undergoing active treatment. Prevention of depression may be an attainable goal, although more research in this area is needed.