Background: Pain, anxiety, and depression are common but often neglected problems in patients with cancer.
Objectives: Considering the importance and impact of anxiety and depression as common psychiatric symptoms in people with cancer, the present study aimed to assess the effectiveness of escitalopram in the reduction of pain, anxiety, and depression in patients with breast cancer.
Methods: This single-blind controlled trial was conducted on 32 patients diagnosed with breast cancer who were referred for modified radical mastectomy (2018-2019). The intervention group received daily oral capsules containing 10 milligrams of escitalopram for four weeks, while the control group received placebo capsules containing starch on a daily basis. Hospital Anxiety and Depression Scale (HADS) and Visual Analogue Scale were administered to the patients at the commencement of the study and four weeks after the intervention. In addition, at baseline examination, personality factors were assessed by the NEO Five-Factor Inventory-3 questionnaire.
Results: Based on the results, the scores of HADS anxiety, total HADS, and pain reduced after the intervention in the case group; however, the HADS depression score demonstrated a slight increase. A significant difference was observed between the case and control groups for HADS anxiety score after the intervention (P=0.01). The correlation of personality characteristics with HADS anxiety and depression subscales pointed out a significant negative correlation between the HADS depression score and conscientiousness (r=-0.40; P<0.05).
Conclusion: Due to minor side effects of escitalopram, this drug is suggested to be used for the reduction of anxiety symptoms and pain intensity in patients with breast cancer.
- Niedzwiedz CL, Knifton L, Robb KA, Katikireddi SV, Smith DJ. Depression and anxiety among people living with and beyond cancer: a growing clinical and research priority. BMC Cancer. 2019;19(1):943. doi: 10.1186/s12885-019-6181-4. [PubMed: 31604468].
- Wondimagegnehu A, Abebe W, Abraha A, Teferra S. Depression and social support among breast cancer patients in Addis Ababa, Ethiopia. BMC Cancer. 2019;19(1):836. doi: 10.1186/s12885-019-6007-4. [PubMed: 31455282].
- Yi JC, Syrjala KL. Anxiety and depression in cancer survivors. Med Clin North Am. 2017;101(6):1099-113. doi: 10.1016/j.mcna.2017.06.005. [PubMed: 28992857].
- Pitman A, Suleman S, Hyde N, Hodgkiss A. Depression and anxiety in patients with cancer. BMJ. 2018;361:k1415. doi: 10.1136/bmj.k1415. [PubMed: 29695476].
- Brandenbarg D, Maass S, Geerse OP, Stegmann ME, Handberg C, Schroevers MJ, et al. A systematic review on the prevalence of symptoms of depression, anxiety and distress in long-term cancer survivors: implications for primary care. Eur J Cancer Care (Engl). 2019;28(3):e13086. doi: 10.1111/ecc.13086. [PubMed: 31087398].
- World Health Organization. Cancer key facts. Geneva: World Health Organization; 2018.
- Farhood B, Geraily G, Alizadeh A. Incidence and mortality of various cancers in Iran and compare to other countries: a review article. Iran J Public Health. 2018;47(3):309-16. [PubMed: 29845017].
- Nikbakhsh N, Moudi S, Abbasian S, Khafri S. Prevalence of depression and anxiety among cancer patients. Caspian J Intern Med. 2014;5(3):167-70. [PubMed: 25202445].
- Busby J, Mills K, Zhang SD, Liberante FG, Cardwell CR. Selective serotonin reuptake inhibitor use and breast cancer survival: a population-based cohort study. Breast Cancer Res. 2018;20(1):4. doi: 10.1186/s13058-017-0928-0. [PubMed: 29351761].
- Ahmed E. Antidepressants in patients with advanced cancer: when they're warranted and how to choose therapy. Oncology (Williston Park). 2019;33(2):62-8. [PubMed: 30784031].
- Desautels C, Savard J, Ivers H, Savard MH, Caplette-Gingras A. Treatment of depressive symptoms in patients with breast cancer: a randomized controlled trial comparing cognitive therapy and bright light therapy. Health Psychol. 2018;37(1):1-13. doi: 10.1037/hea0000539. [PubMed: 29172605].
- Li M, Kennedy EB, Byrne N, Gérin-Lajoie C, Katz MR, Keshavarz H, et al. Management of depression in patients with cancer: a clinical practice guideline. J Oncol Pract. 2016;12(8):747-56. doi: 10.1200/JOP.2016.011072. [PubMed: 27382000].
- Kirino E. Escitalopram for the management of major depressive disorder: a review of its efficacy, safety, and patient acceptability. Patient Prefer Adherence. 2012;6:853-61. doi: 10.2147/PPA.S22495. [PubMed: 23271894].
- Park HY, Lee BJ, Kim JH, Bae JN, Hahm BJ. Rapid improvement of depression and quality of life with escitalopram treatment in outpatients with breast cancer: a 12-week, open-label prospective trial. Prog Neuropsychopharmacol Biol Psychiatry. 2012;36(2):318-23. doi: 10.1016/j.pnpbp.2011.11.010. [PubMed: 22142651].
- Azkhosh M, Asgari A. Five factor model in Iranian culture: a psychometrics analysis of NEO-five factor inventory (NEO-FFI). Int J India Psychol. 2014;1(4):78-101.
- Nazemzadeh M, Jalalodini A, Rezvani M, Yousefian N, Poornamdar Z, Ghalge M. The effect of foot reflexology massage on pain intensity in patients with chronic low back pain visited to physical therapy unit in Baghiathallah hospital in Tehran. Complement Med J Facul Nurs Midwifery. 2012;2(3):1-8.
- Lydiatt WM, Bessette D, Schmid KK, Sayles H, Burke WJ. Prevention of depression with escitalopram in patients undergoing treatment for head and neck cancer: randomized, double-blind, placebo-controlled clinical trial. JAMA Otolaryngol Head Neck Surg. 2013;139(7):678-86. doi: 10.1001/jamaoto.2013.3371. [PubMed: 23788218].
- Schillani G, Capozzo MA, Era D, De Vanna M, Grassi L, Conte MA, et al. Pharmacogenetics of escitalopram and mental adaptation to cancer in palliative care: report of 18 cases. Tumori. 2011;97(3):358-61. doi: 10.1700/912.10034. [PubMed: 21789016].
- Chen J, Lin ZN, Tao YT, Zhao QN, Li Q, Yang H, et al. Influences of personality characteristics and coping modes on anxiety in primary glaucoma patients. Int J Ophthalmol. 2019;12(7):1163-9. doi: 10.18240/ijo.2019.07.18. [PubMed: 31341809].
- Kaplan SC, Levinson CA, Rodebaugh TL, Menatti A, Weeks JW. Social anxiety and the Big Five personality traits: the interactive relationship of trust and openness. Cogn Behav Ther. 2015;44(3):212-22. doi: 10.1080/16506073.2015.1008032. [PubMed: 25705989].
- Bienvenu OJ, Samuels JF, Costa PT, Reti IM, Eaton WW, Nestadt G. Anxiety and depressive disorders and the five‐factor model of personality: a higher‐and lower‐order personality trait investigation in a community sample. Depress Anxiety. 2004;20(2):92-7. doi: 10.1002/da.20026. [PubMed: 15390211].
- Malouff JM, Thorsteinsson EB, Schutte N. The relationship between the five-factor model of personality and symptoms of clinical disorders: a meta-analysis. J Psychopathol Behav Assess. 2005;27(2):101-14. doi: 10.1007/s10862-005-5384-y.
- Schrier AC, de Wit MA, Krol A, Fassaert TJ, Verhoeff AP, Kupka RW, et al. Similar associations between personality dimensions and anxiety or depressive disorders in a population study of Turkish-Dutch, Moroccan-Dutch, and native Dutch subjects. J Nerv Ment Dis. 2013;201(5):421-8. doi: 10.1097/NMD.0b013e31828e110d. [PubMed: 23595096].
- Naylor B, Boag S, Gustin SM. New evidence for a pain personality? A critical review of the last 120 years of pain and personality. Scand J Pain. 2017;17:58-67. doi: 10.1016/j.sjpain.2017.07.011. [PubMed: 28850375].
- Davoodi I, Zargar Y, Mozafari Pour E, Nargesi F, Mola K. The relationship between pain catastrophizing, social support, pain-related anxiety, coping strategies and neuroticism, with functional disability in rheumatic patients. Quart J Health Psychol. 2012;1(1):54-67.
- Qazvini SJ, Kiapei FH, Mirzaian B. Evaluating the relationship between personality traits, coping strategies and pain catastrophizing in patients with chronic pain. Dis Diagn. 2017;6(2):1-3.
- Hjermstad MJ, Fayers PM, Haugen DF, Caraceni A, Hanks GW, Loge JH, et al. Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manage. 2011;41(6):1073-93. doi: 10.1016/j.jpainsymman.2010.08.016. [PubMed: 21621130].
- Stover AM, Basch EM. The potential role of symptom questionnaires in palliative and supportive cancer care delivery. Curr Oncol Rep. 2017;19(2):12. doi: 10.1007/s11912-017-0571-z. [PubMed: 28220450].