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.