Prophylactic use of the SSRI escitalopram decreased the occurrence of depression in patients with head and neck cancers by 50% and resulted in significantly improved quality of life for 3 months after drug cessation, according to the results of the Prevention of Depression in Patients Being Treated for Head and Neck Cancer Trial (PROTECT).
Based on the results of this study, published online in JAMA Otolaryngology—Head & Neck Surgery, the researchers suggested that “prophylactic use of escitalopram should be strongly considered in patients who fit the inclusion criteria for this study.”
According to background information in the article, major depressive disorder has been estimated to occur in anywhere from 11% to 52% of patients diagnosed with head and neck cancers. The onset of depression occurs shortly after diagnosis and has been associated with increased length of hospital stay, the ability of patients to care for themselves, and quality of life.
“Suicide is of particular concern in patients with [head and neck cancers], with rates among the highest of all medically ill patients,” the researchers wrote. “Compounding this problem, many oncologists are not adept at diagnosing and treating depression or identifying the overlap of signs and symptoms of depression with cancer treatment–related adverse effects.”
The PROTECT study was designed to evaluate if the prophylactic use of escitalopram would decrease the incidence of depression in this patient group. The study enrolled 148 patients with head and neck cancers who were currently not depressed and were about to undergo treatment for their disease. The patients were randomly assigned to treatment with escitalopram or placebo, and assessed for depression using the Quick Inventory of Depressive Symptomology–Self Rated scores.
Only 10% of patients treated with escitalopram had depression classified as moderate or greater compared with 24.6% in the placebo group (P = .04), a relative risk reduction of 59.4%. After a multivariate analysis controlling for confounding factors including age, sex, and baseline smoking status, patients assigned escitalopram had a 0.37 hazard ratio (95% CI, 0.14–0.96; P = .04) for depression.
A comparison of depression by treatment type revealed that those patients who received radiation as a primary treatment were more likely to report moderate or greater depression (HR=3.6; 95% CI, 1.38–9.40; P = .009). No participant had suicidality after baseline.
The researchers did point out potential problems with the prophylactic treatment of depression, including adverse effects of the medication and additional costs. Five patients in the placebo group and 14 patients in the treatment group dropped out of the study because of adverse effects.
“Depression is considered to have the greatest associated disability of any medical illness and has an array of costs associated with it,” the researchers wrote. “Although there are many costs associated with adopting a prevention strategy for patients with [head and neck cancers], the availability of low-cost generic antidepressants (including escitalopram) reduces cost as a potential barrier.”