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The abortive clinical trial by Lydiatt et al1 evaluating the use of antidepressants for the prevention of major depression among patients with head and neck cancer is misleading and a travesty in terms of the presentation and interpretation of its results. The upbeat conclusion provided in the abstract has been widely disseminated in the media but should be disqualified because the study was stopped prematurely, intent-to-treat analyses were not conducted, and nonsignificant findings were obtained for the primary outcome.
The incidence of major depression in patients with head and neck cancer is not well documented, but a report stating that 5 of 10 patients in the placebo group developed major depression strains credibility, particularly when readers are not provided with confidence intervals. Lydiatt and colleagues ignored the lack of positive results in previous studies that provided antidepressants to patients with cancer who were selected because they were not clinically depressed. Fisch et al2 attempted to implement a large-scale trial of the use of antidepressants to improve the quality of life in patients with advanced cancer and found that only a small minority of the patients approached consented to participate, and of the patients who did consent, only a minority were available for follow-up assessments. Stockler et al3 found null effects on depressive symptoms and negative effects on survival in patients with advanced cancer who were provided with antidepressants.
The report of Lydiatt and colleagues serves to foster the illusion that all oncologists need to do to improve quality of life and to prevent the development of depression among patients with cancer is to distribute antidepressants. Even among patients in general medical care who are already suffering from major depression, prescribing antidepressants leads only to modest improvement4 without enhancements of routine care to ensure better patient education, adherence, and follow-up care.5 Expectations that treatment with antidepressants can prevent major depression among patients with cancer depend on the minority of the patients actually at risk for major depression obtaining adequate care. This substantial improvement over treatment as usual is unlikely to occur without the infusion of considerable resources, and prospects for this happening are more unlikely if the claims of Lydiatt and colleagues are accepted without criticism.
Correspondence: Dr Coyne, Department of Psychiatry. University of Pennsylvania School of Medicine, 3535 Market St, Room 676, Philadelphia, PA 19104 (jcoyne@mail.med.upenn.edu).
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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