Patients with head and neck cancer (HNC) are disproportionately affected by major depressive disorder (MDD), with up to 50% developing MDD compared to 15-25% of patients with other solid malignancies. The higher rates of depression seen in HNC patients are likely related to treatment-associated disfigurement, voice and swallow dysfunction, and other physical alterations that significantly diminish quality of life. There is evidence to suggest that depression plays a role in HNC cancer prognosis, with studies showing a 25% decrease in overall survival in HNC patients with depression. Despite the prevalence and impact of depression in HNC patients, there has only been one randomized control trial to prevent depression in patients with HNC that showed potential benefit. This study used Escitalopram, a selective-serotonin reuptake inhibitor (SSRI). A more appropriate medication would be one that provided mood stabilization as well as pain modulation, since it is known that HNC treatment can lead to long-term opioid use. Serotonin-norepinephrine reuptake inhibitors (SNRIs) provide dual action against serotonergic and noradrenergic receptors, and have shown to provide superior pain relief than monoaminergic drugs such as SSRIs. The investigators hypothesize that SNRIs will provide mood stabilization and improved pain control in patients undergoing surgical treatment for HNC. The investigators plan to conduct a pilot double-blinded, randomized, placebo-controlled trial using Venlafaxine in HNC patients treated with surgery. Patients who screen negative for MDD using the PHQ-9 preoperatively will be randomized to either Venlafaxine or placebo and will be assessed throughout the perioperative period with a series of validated self-reported questionnaires regarding depression, anxiety, pain, and other quality of life measures. These questionnaires include the PHQ-9, GAD-7, Brief Pain Inventory, and the Memorial Sloan Kettering Cancer Center FACE-Q Head and Neck Cancer questionnaire. Demographic, socioeconomic, and tumor-specific data will be collected in order to better understand variables that contribute to the risk of developing mood disorders during treatment. The investigators propose a randomized clinical trial to intervene early with pharmacologic treatment in order to prevent the development of depression.
This is an double-blinded, randomized controlled clinical trial to determine if Venlafaxine can prevent development of depression in patients undergoing treatment for head and neck cancer.