Preventing Depression in People Who Have Never Had It

Daily Herald (Arlington Heights, IL), October 1, 2017 | Go to article overview

Preventing Depression in People Who Have Never Had It


Byline: Nathaniel Morris Special to The Washington Post

Preventing depression in people who have never had it

If you were at risk for developing depression, would you take a pill to prevent it?

For years, physicians have prescribed antidepressants to treat people grappling with depression. Some people can benefit from taking these medications during an acute episode. Others with a history of recurrent depression may take antidepressants to help prevent relapses.

But researchers are studying a new use for these medications: To prevent depression in people who may have never had it before.

It has long been known that people with head and neck cancer are vulnerable to becoming depressed. These types of cancers can impair functionality at the most basic levels, like speaking or swallowing. Treatments, such as surgery and radiation, for these diseases can be debilitating. Some studies have estimated that up to half of patients with head and neck cancers may experience depression.

A group of researchers in Nebraska examined what would happen if non-depressed patients were given antidepressants before receiving treatment for head and neck cancer. Published in 2013, the results of the randomized, placebo-controlled trial were startling: Patients taking an antidepressant were 60 percent less likely to experience depression compared with peers who were given a placebo.

In medicine, this approach is often referred to as prophylaxis, or a treatment used to prevent disease.

Prophylactic antidepressants have shown promise in other high-risk patient populations as well. A meta-analysis published in 2014 found that prophylactic antidepressants cut down the incidence of depressive episodes among people receiving therapy for hepatitis C by more than 40 percent. Randomized trials suggest that patients who take antidepressants early after a stroke experience significantly lower rates of depression. Small studies have also found that people receiving treatment for melanoma may be less likely to develop depressive symptoms if they are pre-treated with antidepressants.

These findings provide compelling reasons for physicians and patients to consider using these medicines to pre-empt mental-health issues. But this experimental frontier -- which relies on prediction and prevention -- is controversial.

Some critics have raised concerns about the financial incentives behind those who are promoting prophylactic antidepressants. For instance, one of the trials examining depression in stroke patients used the antidepressant escitalopram in the study; readers later discovered a lead author had undisclosed financial ties to Forest Laboratories, a company that manufactures this medication.

Indeed, antidepressants are already among the most widely prescribed medications in the United States; as many as 1 in 8 American adults take these medications each year. …

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