The prevalence and use of antidepressant medication in pediatric cancer patients.
BACKGROUND
During the period of cancer diagnosis and active treatment, several small case series have revealed high rates of psychiatric difficulty in pediatric patients. However, due to the methodological limitations in these studies, it remains impossible to determine accurately the true prevalence of mood disorders in pediatric cancer patients receiving cancer treatment. To date, no study has reported rates of antidepressant treatment in this population.


OBJECTIVE
The aims of this study were: (1) To determine the prevalence of the use of antidepressant medication (ADM) in children with cancer; (2) to identify a group of children being treated for cancer, that are likely to receive ADM, and who therefore may be eligible for a prospective observational or interventional clinical trial of depression during cancer therapy.


METHODS
We reviewed the medical records of 224 pediatric patients suspected for cancer in 2003 at the Children's Medical Center of Dallas. Of these, 6 proved non-oncologic and 2 were lost to follow up, leaving 216 charts for review.


RESULTS
Within 1 year of diagnosis, 29 patients (13%) had received a psychiatric consultation. Twenty-two patients (10.2%) received ADM within 1 year of cancer diagnosis. Children >/= 12 years, children with acute lymphoblastic leukemia, and children receiving radiotherapy or opiate analgesics were more likely to receive ADM by multivariate analysis. Race, sex, bone marrow transplant, and surgery were not significantly associated with ADM use.


CONCLUSIONS
The prevalence of ADM use in pediatric cancer patients (10.2%) was higher than the reported rates of depression (4-8%) and ADM treatment (1%) in the general pediatric population. Teenagers and those who received opiate analgesic medications during their cancer therapy represent a subgroup of children in whom further study of depression and cancer therapy may be valuable.
Portteus
Andrew
A
Department of Pediatric Psychiatry, The University of Texas Southwestern Medical Center at Dallas, Dallas Texas, USA. aportteus@drportteus.com
Ahmad
Naveed
N
Tobey
Daniel
D
Leavey
Patrick
P
D000293:Adolescent; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use*; D002648:Child; D015897:Comorbidity; D003866:Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D004363:Drug Utilization; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D015999:Multivariate Analysis; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D012803:Sick Role
D000701:Analgesics, Opioid; D000928:Antidepressive Agents