In some cases, treatment with antidepressant medication can ease—or even prevent—depression. A randomized, double-blind, placebo-controlled clinical trial found that the prophylactic use of antidepressants significantly reduced the incidence of depression in head and neck cancer patients without a history of depression. Of the 148 patients studied, 24.6% of patients in the placebo group developed depression while undergoing cancer treatment. Just 10% of patients treated with escitalopram developed depression (JAMA Otolaryngol Head Neck Surg. 2013;139:678-686). Interestingly, the patients who received escitalopram also reported a statistically better quality of life three months after stopping the drug.
Explore This IssueApril 2014
“This is level one evidence that we can prevent depression in head and neck cancer patients undergoing treatment,” said Dr. Lydiatt, lead author of the study.
Yet many otolaryngologists are uncomfortable with the idea of prescribing antidepressants to their patients. Additional studies are needed to help physicians better understand the effectiveness of antidepressants in both the treatment and prevention of depression, as well as which patients might benefit most from treatment.
In the meantime, “you have to decide at what level you’re comfortable participating in patients’ mental healthcare,” Dr. Lydiatt said. If you’re interested in diagnosing and treating patients, you need to have tools to assess and measure depression and mental health, and you need to be familiar with common mental health medications.”
“If you’re not comfortable handling mental health conditions, spend a little time developing a plan,” Dr. Lydiatt said. With a plan in place, managing mental health conditions in otolaryngology patients does not take much time, Dr. Lydiatt said. “In fact, I would argue that the time spent up front is more than repaid down the road. Your goal should be to help your patients be well, not just cured.”
Jennifer L.W. Fink is a freelance medical writer based in Wisconsin.