Testing a Strategy for Early Intervention and Prevention of Depression in Lung Cancer Patients: Impact on Multiple Symptoms and Quality of Life

Cancer patients typically have multiple (i.e., as many as 10) psychosocial and palliative care needs. Depression is often under-recognized and undertreated. With the already burdensome treatments that patients endure for curative efforts and management of the disease process, it is important to find treatments for symptom management that have multiple benefits and can even prevent depression. To this end, we hope to undertake a novel and potentially groundbreaking study to explore the effects of mirtazapine (Remeron @) as a prophylactic treatment for preventing depression, by employing it early as a treatment for insomnia. We have previously demonstrated the potential benefits ofthe drug for appetite, weight maintenance and gain, and several other symptoms in depressed cancer patients. It is believed that this single agent, used herein with patients screening high for problems of insomnia, will be of great value as a potential preventative for the onset of depression in this population. We chose to screen for insomnia as a rule-in to the study since insomnia is common in this population (40-60%), which offers us a chance to treat a large number of people, alleviate the symptom of insomnia, and potentially help with other symptoms and preempt the development of depression. Interventions for insomnia have the potential to dramatically improve quality oflife, although this issue has been poorly studied. To date, no prophylactic study of antidepressants for the prevention of major depression has ever been attempted in lung cancer patients.