Supportive Care in Cancer

, Volume 20, Issue 2, pp 375–384

Slow versus standard up-titration of paroxetine for the treatment of depression in cancer patients: a pilot study

  • Laura Amodeo
  • Lorys Castelli
  • Paolo Leombruni
  • Daniela Cipriani
  • Alessia Biancofiore
  • Riccardo Torta
Original Article

DOI: 10.1007/s00520-011-1118-8

Cite this article as:
Amodeo, L., Castelli, L., Leombruni, P. et al. Support Care Cancer (2012) 20: 375. doi:10.1007/s00520-011-1118-8

Abstract

Objectives

This study aimed to compare the tolerability and efficacy of two different titrations of paroxetine (slow and standard) in a population of cancer patients with depression.

Methods

This randomized open trial included 30 cancer patients with depression (major depressive disorder, dysthymic disorder, or adjustment disorder with depressed mood) and aimed to compare the safety of slow up-titration (arm A) versus standard up-titration (arm B) of paroxetine chlorhydrate. In both arms, the maximum final dose was 20 mg/day. Patients were evaluated at baseline and after 2, 4, and 8 weeks with rating scales for depression and anxiety (MADRS, HADS, HAM-A, CGI), quality of life (EORTC-QLQ-30), and side effects (DOTES, SIDE).

Results

Thirty consecutive cancer patients (F = 21; M = 9) meeting DSM-IV TR criteria for mood disorders (MD) were enrolled in the study and randomly assigned to slow or standard paroxetine titration. Both treatment groups showed a significant mood improvement (change in MADRS total score) from baseline to end point (arm A—F(2,18) = 33.68 p < 0.001; arm B—F(2,12) = 6.97 p < 0.005). A significantly higher rate of patients in arm A compared with arm B showed no side effects after 2 weeks (40% vs. 6.7%, respectively). A multinomial logistic regression confirmed such differences between arms (chi square = 20.89 p = 0.004). The self-evaluating scale (SIDE) confirmed this difference: 60% of subjects in arm B perceived side effects compared to only 11.1% of patients in arm A.

Conclusions

The results of this study suggest that slow paroxetine up-titration is better tolerated and at least as effective as the standard paroxetine up-titration in cancer patients with depression.

Keywords

Paroxetine Cancer Mood disorder Slow titration 

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Laura Amodeo
    • 1
  • Lorys Castelli
    • 1
  • Paolo Leombruni
    • 1
  • Daniela Cipriani
    • 1
  • Alessia Biancofiore
    • 1
  • Riccardo Torta
    • 1
  1. 1.Clinical and Oncological Psychology, Department of NeuroscienceUniversity of TurinTurinItaly