Impact Factor:1.137 | Ranking:21/36 in Social Sciences, Biomedical | 81/136 in Public, Environmental & Occupational Health | 5-Year Impact Factor:1.396Source:2012 Journal Citation Reports® (Thomson Reuters, 2013)
Joan L Bottorff joan.bottorff{at}ubc.ca University of British Columbia, Kelowna, CanadaJohn L Oliffe University of British Columbia, Vancouver, CanadaMary T Kelly University of British Columbia, Vancouver, CanadaJoy L Johnson University of British Columbia, Vancouver, CanadaJoanne Carey University of British Columbia, Kelowna, CanadaWhile men’s gendered experiences of depression have been described, the perspectives of women partners who are affected by men’s depression have received little attention. Women partners were recruited to explore how men’s depression impacts them and its influence on gender regimes. Individual interviews with 29 women spouses were coded and analysed. Although idealized femininity positions women as endlessly patient and caring, our findings reveal significant challenges in attempting to fulfil these gender ideals in the context of living with a male partner who is experiencing depression. The strain and drain of living with a depressed man was a key element of women’s experiences. Four sub-themes were identified: (1) resisting the emotional caregiver role, (2) shouldering family responsibilities, (3) connecting men to professional care and (4) preserving the feminine self. The findings suggest that men’s depression has great potential to dislocate heterosexual gender regimes, and attention to gender relations should be included to ensure successful care management of men who experience depression. © 2013 SAGE Publications. Los Angeles, London, New Delhi, Singapore and Washington DC
Prophylactic escitalopram cut the incidence of depression in head and neck cancer patients by more than 50% and improved quality of life, a clinical trial showed.
Significantly fewer patients taking the antidepressant developed depression, when compared with those on placebo (10% vs 24.6%; stratified log-rank test, P=.04), according to a study in the June 20 issue of JAMA Otolaryngology Head and Neck Surgery.
"Depression is very common among patients with this disease, but it is not easy to predict who will become depressed at the beginning of treatment," University of Nebraska Medical Center professor of head and neck oncology William Lydiatt, MD, told MedPage Today. "That's why the prevention paradigm may offer considerable benefit at an acceptable risk."
As many as half of head and neck cancer patients develop clinical depression within months of their diagnosis and suicide rates are among the highest in patients with a medical illness, Lydiatt noted.
"The burden of treatment is extensive and frequently includes dysphagia, disfigurement, voice alterations, mucositis, need for tracheostomy and feeding tubes, fatigue and depression," the researchers wrote.
They chose the generic version of the popular SSRI Lexapro for the trial to give patients an affordable treatment option that's well tolerated in the elderly.
The randomized, double-blind trial included 148 newly diagnosed head and neck cancer patients entering treatment who did not yet have a diagnosis of depression. The patients were stratified by sex, site of disease, stage, and primary modality of treatment (surgery versus radiation).
Half were treated with escitalopram at a dosage of 10 mg/d for the first week (one tablet) followed by 20 mg/d (two tablets) until week 16, followed by an additional week of 10 mg/d. During the acute phase of the study, dosage was reduced to 10 mg/d when adverse events occurred. Patients not treated with the antidepressant received matching placebo pills.
Among the study's major findings: Patients undergoing radiation as their initial therapy were significantly more likely than those who had surgery to develop depression (hazard ratio, 3.6; 95% CI ,1.38-9.40; P=.009).A Cox progression hazards regression model comparing the two groups, after controlling for age, smoking status, and other variables, demonstrated an advantage for escitalopram (hazard ratio, 0.37; 95% CI, 0.14-0.96: P=.04).Patients who took escitalopram and who completed the study without developing depression rated their overall quality of life as significantly better than those in the placebo group for 3 consecutive months after ending treatment with the antidepressant (overall quality of life, good or outstanding at weeks 20, 24 and 28 - escitalopram group = 96%, 100%, 96%, respectively; placebo group = 77%, 86%, 85%).
Lydiatt said the finding that radiotherapy patients had a higher risk for depression than surgery patients is a big surprise with important potential clinical implications.
"The higher incidence of depression in the cohort receiving radiation suggests that radiation represents a greater and longer duration stress event than surgery," the researchers wrote. "Radiation may also generate greater inflammatory cytokines during treatment, which could contribute to the higher rate (of depression)."
Although overall treatment success and survival were not study endpoints, Lydiatt said he hopes to conduct further research with these outcomes in mind.
"I would not be surprised to see a survival advantage associated with this approach," he said. "Depression is associated with so many negative manifestations in these patients. Depressed patients don't comply with their treatments to the same degree as patients who aren't depressed and they don't take care of themselves as well. They often lose their spark to live.
This study was funded by a grant from the National Institute of Mental Health. Additional support was provided by a research fund grand from the Nebraska Medical Center and the University of Nebraska Medical Center.
By Ed Susman, Contributing Writer, MedPage Today Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.Note that this study of patients with Parkinson's disease and healthy controls demonstrated a strong association between mild cognitive impairment and worse scores on standardized tests for depression and anxiety.Be aware that the cross-sectional nature of the study precludes a formal assessment of causality.