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Citalopram Prevents Depression in Head and Neck Cancer Patients but Effect on Tobacco Cessation Uncertain

By John Otrompke

CHICAGO, IL -- August 22, 2006 -- The selective serotonin reuptake inhibitor Celexa (citalopram) shows efficacy in treating depression in patients with recently-diagnosed head and neck cancer, according to research presented here at the 2006 annual meeting of the American Head and Neck Society (AHNS).

"Depression is a significant problem: it decreases immune function, adherence to therapy, and the ability of patients to seek medical attention, and it may even decrease survival," said Bill Lydiatt, MD, associate professor, head and neck surgery, University of Nebraska Medical Center, Omaha, Nebraska.

Previous studies have shown that 19% of all hospital suicides in cancer patients occur in those with head and neck cancer, who make up 2% to 3% of all cancer patients, said Dr. Lydiatt, who presented scientific the findings at the conference on August 18^th.

The high suicide rate among head and neck cancer patients occurs because the disease "impairs the most basic aspects of your humanity, including speech, swallowing, and facial appearance," he explained.

In the study, 36 subjects with head and neck cancer were randomized to Celexa or placebo, and 23 completed the 12-weeks of treatment. Depression was assessed using the Hamilton Depression Rating Scale, the Geriatric Depression Scale, and the Collateral Source Geriatric Depression Scale.

At 12 weeks, 50% of patients in the placebo group experienced clinically significant depression compared with 15% in the Celexa group. Two patients in the placebo arm experienced suicidal ideation compared with none in the Celexa arm.

At 12 weeks, 50% of those in the placebo arm experienced depression at any 1 time, and this figure was 60% at the 16-week follow-up visit. The figure in the Celexa arm remained 13% at both follow-up periods, Dr. Lydiatt said.

"One of the secondary goals of the study was to reduce tobacco and alcohol use. At the time of entry many patients had quit, and we had reduction in both arms, but the number was very small, so we couldn't adequately address that issue," Dr. Lydiatt said.

"We need a larger [study] group," he added. "Because our expected drop-out rate is 40%, we're proposing a group of 160 patients."


[Presentation title: Randomized Placebo-Controlled Trial of Citaprolam Demonstrating Depression Prevention During Treatment for HN Cancer. Abstract S 032]

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