title: Slow versus standard up-titration of paroxetine for the treatment of depression in cancer patients: a pilot study.
abstract: OBJECTIVE
  This study aimed to compare the tolerability and efficacy of two different titrations of paroxetine (slow and standard) in a population of cancer patients with depression.
  
  
  METHODS
  This randomized open trial included 30 cancer patients with depression (major depressive disorder, dysthymic disorder, or adjustment disorder with depressed mood) and aimed to compare the safety of slow up-titration (arm A) versus standard up-titration (arm B) of paroxetine chlorhydrate. In both arms, the maximum final dose was 20 mg/day. Patients were evaluated at baseline and after 2, 4, and 8 weeks with rating scales for depression and anxiety (MADRS, HADS, HAM-A, CGI), quality of life (EORTC-QLQ-30), and side effects (DOTES, SIDE).
  
  
  RESULTS
  Thirty consecutive cancer patients (F = 21; M = 9) meeting DSM-IV TR criteria for mood disorders (MD) were enrolled in the study and randomly assigned to slow or standard paroxetine titration. Both treatment groups showed a significant mood improvement (change in MADRS total score) from baseline to end point (arm A-F(2,18) = 33.68 p < 0.001; arm B-F(2,12) = 6.97 p < 0.005). A significantly higher rate of patients in arm A compared with arm B showed no side effects after 2 weeks (40% vs. 6.7%, respectively). A multinomial logistic regression confirmed such differences between arms (chi square = 20.89 p = 0.004). The self-evaluating scale (SIDE) confirmed this difference: 60% of subjects in arm B perceived side effects compared to only 11.1% of patients in arm A.
  
  
  CONCLUSIONS
  The results of this study suggest that slow paroxetine up-titration is better tolerated and at least as effective as the standard paroxetine up-titration in cancer patients with depression.
authors.affiliation: Clinical and Oncological Psychology, Department of Neuroscience, University of Turin, Corso Bramante 88, 10126 Turin, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Amodeo
authors.forename: Lorys
authors.initials: L
authors.lastname: Castelli
authors.forename: Paolo
authors.initials: P
authors.lastname: Leombruni
authors.forename: Daniela
authors.initials: D
authors.lastname: Cipriani
authors.forename: Alessia
authors.initials: A
authors.lastname: Biancofiore
authors.forename: Riccardo
authors.initials: R
authors.lastname: Torta
mesh_terms: D000275:Adjustment Disorders / Q000188:drug therapy* / Q000209:etiology; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000209:etiology; D004334:Drug Administration Schedule; D019263:Dysthymic Disorder / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D017374:Paroxetine / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D000928:Antidepressive Agents; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors