Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-19T11:14:24.910Z Has data issue: false hasContentIssue false
  • English
  • Français

An open label pilot study of citalopram for depression and boredom in ambulatory cancer patients

Published online by Cambridge University Press:  29 April 2003

DALE E. THEOBALD ,
KENNETH L. KIRSH ,
ELIZABETH HOLTSCLAW ,
KATHLEEN DONAGHY  and
STEVEN D. PASSIK
DALE E. THEOBALD
Affiliation:
Oncology Symptom Control & Research, Community Cancer Care, Indianapolis, Indiana
KENNETH L. KIRSH
Affiliation:
Markey Cancer Center, University of Kentucky Cancer Center, Lexington, Kentucky
ELIZABETH HOLTSCLAW
Affiliation:
Oncology Symptom Control & Research, Community Cancer Care, Indianapolis, Indiana
KATHLEEN DONAGHY
Affiliation:
Oncology Symptom Control & Research, Community Cancer Care, Indianapolis, Indiana
STEVEN D. PASSIK
Affiliation:
Markey Cancer Center, University of Kentucky Cancer Center, Lexington, Kentucky
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective: Significant levels of depressive symptoms are an impediment to adjustment and affect greater than one-third of people with cancer. The clinical diagnosis of major depression is estimated to occur in 25%. Depression is dramatically underrecognized by oncologists and oncology nurses, and as a result, often undertreated. Clinical experience suggests that antidepressants of virtually all types are well tolerated and potentially efficacious. There is, however, a lack of an evidence base for the use of antidepressants in cancer patients.

Methods: We undertook an open-label pilot study using citalopram in 30 cancer patients who reported a high level of depressive symptoms on the Zung Self-Rating Depression Scale (ZSDS). In addition to the ZSDS, eligible patients completed a series of visual analog scales for pain, depression, and sleep disturbance; the Functional Assessment of Cancer Therapy-General Module; and the Purposelessness, Understimulation, and Boredom Scale developed by the research team. Patients began a 2-month course of therapy with citalopram 20 mg, increasing to 40 mg at the end of the fourth week if the patient was in the same range of depressive symptoms as measured by the ZSDS.

Results: Twenty-one of 30 patients completed the protocol. The average age of the sample was 57.32 years (SD = 12.6) and was comprised of 11 women (52.4%) and 10 men (47.6%). Depressive symptoms decreased and quality of life improved during the 8-week treatment period. Of special interest was the rate of improvement in boredom, and using the total boredom score of the PUB, significant improvement compared to baseline was seen in weeks 6 (F = 5.266, p < .05) and 8 (F = 9.248, p < .01).

Significance of results: Overall, the positive findings suggest the need for a randomized, double-blind, placebo-controlled trial of citalopram in cancer patients. Regarding the interplay of boredom and depression, the relationship between improvements in depressive symptoms and boredom is complex. This is illustrated by the way in which the different elements respond to antidepressant treatment. Depression began to improve almost immediately upon initiation of treatment whereas improvement in boredom does not become evident until week 6.

Keywords

CitalopramDepressionBoredomCancer
Type
Research Article
Information
Palliative & Supportive Care , Volume 1 , Issue 1 , March 2003 , pp. 71 - 77
Copyright
© 2003 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Breitbart, W. & Passik, S.D. (1993). Psychiatric aspects of palliative care. In The Oxford Textbook of Palliative Medicine, Doyle, E., Hanks, G., & MacDonald, N. (eds.), pp. 607–626. New York: Oxford University Press.
Brescia, F.J. (1993). Pain management issues as part of the comprehensive care of the cancer patient. Seminars in Oncology, 2(Suppl. 1), 48–52.Google Scholar
Cella, D.F., Tulsky, D.S., & Gray, G. et al. (1993). The functional assessment of cancer therapy scale (FACT) scale: Development and validation of the general measure. Journal of Clinical Oncology, 11, 570–579.Google Scholar
Dugan, W.M., Passik, S.D., McDonald, M., Rosenfeld, B.D., Theobald, D.E., & Edgerton, S. (1998). The use of the Zung self-rating depression rating scale as a screening tool in cancer patients. Psycho-oncology, 7, 483–493.Google Scholar
Fisch, M.J., Loehrer, P.J., Passik, S.D., Kristellar, J.L., Jung, S., & Einhorn, L.H. (2001). Fluoxetine versus placebo in advanced cancer patients outpatients: A placebo-controlled, double-masked trial of the Hoosier Oncology Group. Proceedings of the Annual Meeting of the American Society of Clinical Oncologist, 20, Abstract 1530.
Keller, M.B. (2000). Citalopram therapy for depression: A review of 10 years of European experience and data from U.S. clinical trials. Journal of Clinical Psychology, 61, 896–908.Google Scholar
Loprinzi, C.L., Kugler, J.W., Sloan, J., Maillaird, J.A., LaVasseur, B.I., Barton, D.L., Novotny, P.J., Dakhil, S.R., Rodger, K., Rummons, T.A., & Christensen, B.J. (2000). Venlafaxine in management of hot flashes in survivors of breast cancer: A randomized controlled trial. Lancet, 356, 2059–2063.Google Scholar
Lovejoy, N.C., Tabor, D., & Deloney, P. (2000). Cancer-related depression: Part II—Neurologic alterations and evolving approaches to psychopharmacology. Oncology Nursing Forum, 27, 795–808.Google Scholar
McDonald, M., Passik, S.D., Dugan, W.M., Rosenfeld, B., Theobald, D.E., & Edgerton, S. (1999). Nurses' recognition of depression in their patients with cancer. Oncology Nursing Forum, 26, 593–599.Google Scholar
Passik, S.D., Dugan, W.M., McDonald, M., Rosenfeld, B.D., Theobald, D.E., & Edgerton, S. (1998a). Oncologists' recognition of depression in their patients with cancer. Journal of Clinical Oncology, 16, 1594–1600.Google Scholar
Passik, S.D., Inman, A., Kirsh, K., Theobald, D.E., & Dickerson, P. (2003). Initial validation of a scale to measure purposelessness, understimulation, and boredom in cancer patients: Toward a redefinition of depression in advanced disease. Palliative and Supportive Care, 1, 41–50.Google Scholar
Passik, S.D., Kirsh, K.L., Theobald, D., Donaghy, K., Holtsclaw, E., Edgerton, S., & Dugan, W. (2002). Use of a depression screening tool and a fluoxetine-based algorithm to improve the recognition and treatment of depression in cancer patients: A demonstration project. Journal of Pain and Symptom Management, 24(3), 318–327.Google Scholar
Passik, S.D., Theobald, D.E., Donaghy, K.B., Heminger, E.F., & Dugan, W.M. (1998b). Why we do what we do: The importance of psycho-oncology and quality-of-life research to the practicing oncologist. Specialist Medicine, 20(3), 46–51.Google Scholar
Portenoy, R.K. & Bruera, E. (1998). Preface to the series. In Topics in Palliative Care, Vol. 3, Portenoy, R.K. & Bruera, E. (eds.), pp. vii–viii. New York: Oxford University Press.
Portenoy, R.K., Thaler, H.T., Kornblith, A.B., McCarthy Lepore, J., Friedlander-Klar, H., Kiyasu, E., Sobel, K., Coyle, N., Kemeny, N., Norton, L., & Scher, H. (1994). The memorial symptom assessment scale: An instrument for the evaluation of symptom prevalence, characteristics and distress. European Journal of Cancer, 30A, 1326–1336.Google Scholar
Quella, S.K., Loprinzi, C.L., Sloan, J., Novotny, P., Perez, E.A., Burch, P.A., Antolak, S.J., & Pisansky, T.M. (1999). Pilot investigation of venlafaxine for the treatment of hot flashes in men undergoing androgen ablation therapy for prostate cancer. Journal of Urology, 162, 98–112.Google Scholar
Roscoe, J.A., Morrow, G.R., Hickok, J.T., Bushunow, P., Matteson, S., Rakita, D., & Andrews, P.L. (2002). Temporal interrelationships among fatigue, circadian rhythm and depression in breast cancer patients undergoing chemotherapy treatment. Supportive Care in Cancer, 10, 329–36.Google Scholar
Sivesind, D. & Baile, W. (2001). The psychologic distress in patients with cancer. Nursing Clinics of North America, 36, 809–825.Google Scholar
Theobald, D.E., Kirsh, K.L., Holtsclaw, E., Donaghy, K., & Passik, S.D. (2001). An open label crossover trial of mirtazapine (15 and 30 mgs) in cancer patients with pain and other distressing symptoms. Journal of Pain and Symptom Management, 21, 273–281.Google Scholar
Zung, W.W. (1965). A self-rating depression scale. Archives of General Psychiatry, 12, 63–70.Google Scholar