A randomized, placebo-controlled trial of citalopram for the prevention of major depression during treatment for head and neck cancer.
OBJECTIVE
To determine whether prophylactic treatment with the antidepressant citalopram hydrobromide, compared with placebo, could prevent major depressive disorder in patients undergoing therapy for head and neck cancer (HNC).


METHODS
Prospective, randomized, placebo-controlled trial.


METHODS
Academic medical center.


METHODS
Thirty-six subjects were randomized, and 23 completed the study.


METHODS
Subjects were randomized to receive 40 mg of citalopram hydrobromide or matching placebo (herein after, citalopram group and placebo group, respectively) for 12 weeks with a final visit at 16 weeks.


METHODS
The Hamilton Depression Rating Scale, psychiatric interview, and the University of Washington Quality of Life (UW-QOL) and Clinician Global Impression-Severity (CGI-S) scales.


RESULTS
The numbers of subjects who met predefined cutoff criteria for depression during the 12 weeks of active study were 5 of 10 (50%) taking placebo and 2 of 12 (17%) taking citalopram (Fisher exact test, P = .17). No patients in the citalopram group became suicidal, compared with 2 in the placebo group. Global mood state at the conclusion of the study as measured by the CGI-S scale was rated as at least mildly ill in 15% of those receiving citalopram compared with 60% in the placebo group (Fisher exact test, P = .04). Quality of life, measured by the UW-QOL, deteriorated in both groups from baseline but less so in the citalopram group.


CONCLUSIONS
This study reports data from the first depression prevention trial in HNC and suggests that prophylactic treatment may decrease the incidence of depression during HNC therapy. The clinical significance of the reduction in depression was best demonstrated by the CGI-S scale, which showed a notable difference in global psychiatric and physical well-being.
Lydiatt
William M
WM
Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center, Omaha, NE 68198-1225, USA. wmlydiat@unmc.edu
Denman
David
D
McNeilly
Dennis P
DP
Puumula
Susan E
SE
Burke
William J
WJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D015283:Citalopram / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006258:Head and Neck Neoplasms / Q000523:psychology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D000092864:Suicide Prevention
D018687:Antidepressive Agents, Second-Generation; D015283:Citalopram