A key difficulty in recognizing and diagnosing depression in head and neck patients results from the fact that the side effects of radiation, such as fatigue and sleep disturbance, are also some of the symptoms of depression, said Dr. Lydiatt.
Explore This IssueAugust 2018
Dr. Lydiatt suggested that even for most patients who do not have a diagnosis of depression at baseline, adding prophylactic treatment of depression into the treatment planning could be considered. Results of the recent prevention study showed that patients who received prophylactic antidepressant medication had an overall 50% reduction in depression compared to patients who did not receive such treatment.
“We have randomized evidence that if we start an antidepressant prior to radiation therapy, we can reduce depression,” he said. “This is one strategy that could be considered in our attempts to reduce the burden of depression among our head and neck cancer patients.”
Dr. Williams, on the other hand, questioned whether the benefits of giving an antidepressant to all patients outweigh the risks of antidepressants. She noted that many antidepressants can interact with chemotherapeutics and with antinauseants, such as Zofran and Compazine, and can carry the risk of hyponatremia. “I would argue that antidepressants are not without risk, while the regular, appropriate screening for distress and referral to a behavioral health specialist for evaluation and recommendations would better serve this patient population,” she said.
Expanding Multidisciplinary Team: Role of a Behavioral Health Specialist
Incorporating a behavioral health specialist into the multidisciplinary team providing care, or referring patients to a behavioral specialist, is another strategy that otolaryngologists may want to adopt. “If the treating provider believes that the patient is struggling and/or is nonadherent to treatment and/or the patient is reporting distress, a referral to a behavioral health specialist would be appropriate,” said Dr. Williams, “similar to how the ENT doc/team would refer to a nephrologist for renal issues or endocrinology for identified endocrine issues that are out of the scope of practice for an ENT provider.”
Along with antidepressant therapies, she underscored the importance of psychotherapy for some patients as a treatment option that has longer-lasting effects than medication and that doesn’t interfere with medical treatment. Dr. Williams said that such a specialist can provide psychotherapy assistance during the medical treatments, such as chemotherapy infusions, or following their radiation therapy sessions.
Overall, she emphasized that “the behavioral health specialist works with the patient to manage distress that can interfere in treatment and prevent the longer clinic visits with the ENT provider when the patient is distressed.”