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Evaluating the Effectiveness of Escitalopram to Prevent Depression in Head and Neck Cancer Patients Receiving Treatment

Prevention of Depression in Patients Being Treated for Head and Neck Cancer

Status
Completed
Phases
Phase 4
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00536172
Acronym
PROTECT
Enrollment
160
Registered
2007-09-27
Start date
2007-12-01
Completion date
2012-06-01
Last updated
2023-09-21

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Depression

Keywords

Antidepressant, Major depression, Prevention, Head and neck cancer

Brief summary

This study will evaluate the effectiveness of escitalopram to prevent depression in head and neck cancer patients receiving treatment.

Detailed description

Most types of head and neck cancer develop in the lining of cells found within many parts of the head and neck. Each year, more than 40,000 adults are diagnosed with head and neck cancer in the United States. The leading cause of this type of cancer is tobacco use. Common signs and symptoms of head and neck cancer include blood in saliva; frequent nose bleeds; and difficulty chewing, swallowing, or breathing. Effective treatments for head and neck cancer are available if the cancer is found in its early stages. However, treatment is difficult, causing many people to become depressed within 3 months of being diagnosed. Unfortunately, depression can lead to delays in treatment, impair quality of life, and decrease long-term survival. The purpose of this study is to determine whether the use of antidepressant medication initiated prior to starting treatment will prevent the onset of depression during treatment in non-depressed head and neck cancer patients. This study will also determine if escitalopram will maintain quality of life during treatment, improve participation in treatment, decrease delays and premature discontinuation of treatment, and reduce alcohol and tobacco use in patients with head and neck cancer. All participants will attend an initial screening, followed by eight clinic visits. The first clinic visit will include completion of an interview and brief questionnaires regarding depression, mental and emotional health, alcohol and tobacco use, and quality of life. Participants will then be randomly assigned to receive 16 weeks of the antidepressant escitalopram or a placebo pill. Participants will take 10 mg of their assigned medication every day for the first week and then 20 mg of their assigned medication every day for the remaining 15 weeks. Participants will visit the clinic every 2 weeks during treatment, at which time they will answer questions similar to those asked at the initial visit. Any medication side effects will also be recorded at each visit. Once treatment has been completed, participants will visit the clinic three more times over a period of 12 weeks. Similar questions as those at treatment visits will be asked. Results from this study will be used to assess whether depression is preventable in head and neck cancer patients if antidepressant medication is initiated before treatment begins.

Interventions

DRUGEscitalopram

Participants take 10 mg for 1 week and then 20 mg for 15 weeks.

DRUGPlacebo

Placebo distribution matches the active medication.

Sponsors

National Institute of Mental Health (NIMH)
CollaboratorNIH
University of Nebraska
Lead SponsorOTHER

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)

Eligibility

Sex/Gender
ALL
Age
19 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Newly diagnosed or recurrent epidermoid cancer of the head and neck * Requires more than minimal therapy for treatment * Able to read and write in English * Willing to use an effective form of birth control throughout the study

Exclusion criteria

* Meets MINI criteria for major depression, schizophrenia, or bipolar illness or scores 24 or less * Suicidal or psychotic * Current allergy or hypersensitivity to citalopram or other SSRIs * Treated with monoamine oxidase inhibitors 14 days prior to study entry * Use of antidepressants within 1 week of study entry * Pregnant or breastfeeding * History of an adequate cancer operation, radiation, or chemotherapy within 6 months of study entry * Diagnosed with melanoma or lymphoma cancer of the head and neck * Currently participating in another research study involving a therapeutic intervention

Design outcomes

Primary

MeasureTime frameDescription
Depression as Assessed by the Quick Inventory of Depressive Symptomatology-Self Rated 16 (QIDS-SR-16)Measured pre-treatment and at Weeks 2, 4, 6, 8, 10, 12, 16, 20, 24, and 28Number of participants reaching pre-defined threshold on the QIDS-SR-16 of \>/=11. The QIDS-SR-16 total score ranges from 0-27. Scores ranging from 0 to 10 correspond with no to mild depression, while scores \>/= 11 correspond to moderate to severe depression.

Countries

United States

Participant flow

Recruitment details

298 patients were screened for possible study eligibility from January 6, 2008, to December 28, 2011. 160 subjects agreed to participate.

Pre-assignment details

12 of the 160 subjects who agreed to participate were not eligible: 9 QIDS or QIDS-C \>/=11; 1 not able/willing to return for follow-up; 1 received antidepressants in the past week; 1 not diagnosed with epidermoid cancer and meets MINI criteria for depression. The remaining 148 subjects were randomized.

Participants by arm

ArmCount
Escitalopram
Participants will receive treatment with escitalopram Escitalopram: Participants take 10 mg for 1 week and then 20 mg for 15 weeks.
74
Placebo
Participants will receive treatment with placebo Placebo: Placebo distribution matches the active medication.
74
Total148

Baseline characteristics

CharacteristicEscitalopramPlaceboTotal
Age, Categorical
<=18 years
0 Participants0 Participants0 Participants
Age, Categorical
>=65 years
32 Participants31 Participants63 Participants
Age, Categorical
Between 18 and 65 years
42 Participants43 Participants85 Participants
Age, Continuous63.2 years
STANDARD_DEVIATION 11.3
62.8 years
STANDARD_DEVIATION 12.5
63.0 years
STANDARD_DEVIATION 11.9
Cancer Site
oral
29 participants36 participants65 participants
Cancer Site
pharynx
25 participants24 participants49 participants
Cancer Site
salivary gland
6 participants5 participants11 participants
Cancer Site
sinus
5 participants1 participants6 participants
Cancer Site
skin
9 participants8 participants17 participants
Cancer Type
missing
0 participants2 participants2 participants
Cancer Type
salivary gland
5 participants5 participants10 participants
Cancer Type
skin
4 participants0 participants4 participants
Cancer Type
squamous cell
65 participants67 participants132 participants
Clinical Stage
II
17 participants18 participants35 participants
Clinical Stage
III/IV
57 participants56 participants113 participants
Ethnicity (NIH/OMB)
Hispanic or Latino
2 Participants1 Participants3 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
72 Participants73 Participants145 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants
Initial Treatment Type (Surgery or Radiation)
radiation with/without chemotherapy
32 participants35 participants67 participants
Initial Treatment Type (Surgery or Radiation)
surgery, not biopsy
42 participants39 participants81 participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Asian
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Black or African American
2 Participants3 Participants5 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants
Race (NIH/OMB)
White
72 Participants71 Participants143 Participants
Region of Enrollment
United States
74 participants74 participants148 participants
Sex: Female, Male
Female
15 Participants15 Participants30 Participants
Sex: Female, Male
Male
59 Participants59 Participants118 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
16 / 7413 / 74
other
Total, other adverse events
47 / 7449 / 74
serious
Total, serious adverse events
16 / 7413 / 74

Outcome results

Primary

Depression as Assessed by the Quick Inventory of Depressive Symptomatology-Self Rated 16 (QIDS-SR-16)

Number of participants reaching pre-defined threshold on the QIDS-SR-16 of \>/=11. The QIDS-SR-16 total score ranges from 0-27. Scores ranging from 0 to 10 correspond with no to mild depression, while scores \>/= 11 correspond to moderate to severe depression.

Time frame: Measured pre-treatment and at Weeks 2, 4, 6, 8, 10, 12, 16, 20, 24, and 28

Population: Evaluable subjects

ArmMeasureValue (NUMBER)
EscitalopramDepression as Assessed by the Quick Inventory of Depressive Symptomatology-Self Rated 16 (QIDS-SR-16)6 participants
PlaceboDepression as Assessed by the Quick Inventory of Depressive Symptomatology-Self Rated 16 (QIDS-SR-16)16 participants

Source: ClinicalTrials.gov · Data processed: Mar 10, 2026