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Original Investigation |

Prevention of Depression With Escitalopram in Patients Undergoing Treatment for Head and Neck Cancer:  Randomized, Double-blind, Placebo-Controlled Clinical Trial

William M. Lydiatt, MD1; Diane Bessette, PA2; Kendra K. Schmid, PhD3; Harlan Sayles, MS3; William J. Burke, MD2
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Nebraska Methodist Hospital, University of Nebraska Medical Center, Omaha, Nebraska
2Department of Psychiatry, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
3Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
JAMA Otolaryngol Head Neck Surg. 2013;139(7):678-686. doi:10.1001/jamaoto.2013.3371.
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Importance  Major depressive disorder develops in up to half the patients undergoing treatment for head and neck cancer, resulting in significant morbidity; therefore, preventing depression during cancer treatment may be of great benefit.

Objective  To determine whether prophylactic use of the antidepressant escitalopram oxalate would decrease the incidence of depression in patients receiving primary therapy for head and neck cancer.

Design, Setting, and Participants  A randomized, double-blind, placebo-controlled trial of escitalopram vs placebo was conducted in a group of nondepressed patients diagnosed as having head and neck cancer who were about to enter cancer treatment. Patients were stratified by sex, site, stage (early vs advanced), and primary modality of treatment (radiation vs surgery).

Main Outcome and Measure  The primary outcome measure was the number of participants who developed moderate or greater depression (scores on the Quick Inventory of Depressive Symptomology–Self Rated of ≥11).

Results  From January 6, 2008, to December 28, 2011, 148 patients were randomized. Significantly fewer patients receiving escitalopram developed depression (24.6% in the placebo group vs 10.0% in the escitalopram group; stratified log-rank test, P = .04). A Cox proportional hazards regression model compared the 2 treatment groups after controlling for age, baseline smoking status, and stratification variables. The hazard ratio of 0.37 (95% CI, 0.14-0.96) demonstrated an advantage of escitalopram (P = .04). Patients undergoing radiotherapy as the initial modality were significantly more likely to develop depression than those undergoing surgery (radiotherapy compared with surgery group; hazard ratio, 3.6; 95% CI, 1.38-9.40; P = .009). Patients in the escitalopram group who completed the study and were not depressed rated their overall quality of life as significantly better for 3 consecutive months after cessation of drug use.

Conclusions and Relevance  In nondepressed patients undergoing treatment for head and neck cancer, prophylactic escitalopram reduced the risk of developing depression by more than 50%. In nondepressed patients who completed the trial, quality of life was also significantly better for 3 consecutive months after cessation of drug use in the escitalopram group. These findings have important implications for the treatment of patients with head and neck cancer.

Trial Registration  clinicaltrials.gov Identifier: NCT00536172

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Figure 1.
Patient Enrollment

MINI indicates Mini-International Neuropsychiatric Interview; QID-C, Quick Inventory of Depressive Symptomatology–Clinician; and QID-SR, Quick Inventory of Depressive Symptomatology–Self Rated.

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Figure 2.
Product Limit Estimates

A, Kaplan-Meier curve depicting depression-free survival by treatment assignment (P = .42). B, Comparison of mean depression rates for placebo vs escitalopram oxalate by initial cancer treatment. Error bars indicate SDs.

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