Anxiety and depression in cancer patients: relation between the Hospital Anxiety and Depression Scale and the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire.

BACKGROUND: The emotional functioning (EF) dimension of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ C33) and the Hospital Anxiety and Depression Scale (HADS) evaluate anxiety and depression. We wanted to compare cancer patients' responses to EF with those to HADS, as well as the impact of anxiety and depression on the quality of life (QL) dimensions of the EORTC QLQ C33. METHOD: A total of 568 cancer patients completed both the EORTC QLQ C33 and HADS at the same occasion. The association between the patients' EF scorings and their HADS scores was analyzed by multiple linear regression. Gender and age were included as covariates. RESULTS: Statistically significant negative relations were found between EF and HADS-A (anxiety), HADS-D (depression) and HADS-T (total score), respectively, with the highest correlation coefficient for HADS-A. Older patients and males reported less emotional distress assessed by the EF scale than younger ones and females with comparable HADS-T or HADS-D scores. Both HADS-A and HADS-D were significantly related to other QL dimensions, and depression was a stronger predictor for reduced QL than anxiety. CONCLUSION: The EF dimension of EORTC QLQ C33 predominantly assesses anxiety, whereas depression is rated to a lesser degree. Combined with significant age and gender relations, this implies a risk of underdiagnosed depression, if the EORTC QLQ C33 is used as the only instrument to screen for psychological distress in cancer patients. As depression has a stronger impact on global QL of cancer patients than anxiety, the use of an additional instrument is recommended for assessment of depression.

Efficacy and tolerability of mirtazapine versus citalopram: a double-blind, randomized study in patients with major depressive disorder. Nordic Antidepressant Study Group.

We aimed to compare the antidepressant and anxiolytic effects, tolerability and effects on quality of life of mirtazapine and citalopram in a randomized, double-blind, multicentre, 8-week study. Patients with a Major Depressive Episode (DSM-IV) and a baseline score of > or = 22 on the Montgomery-Asberg Depression Rating Scale (MADRS) were randomized to 8 weeks treatment with either mirtazapine (n = 137, 15-60 mg/day) or citalopram (n = 133, 20-60 mg/day). Efficacy was evaluated by the MADRS, Hamilton Anxiety Scale (HAM-A), Clinical Global Impression scales (CGI), the Leeds Sleep Evaluation Questionnaire (LSEQ) and Quality of Life Enjoyment and Satisfaction Questionnaire (QLESQ). The efficacy analyses were performed on the Intent-To-Treat Group using the Last Observation Carried Forward method. Vital signs and laboratory variables are measured and adverse events recorded at each weekly visit. The magnitude of reduction from baseline in group mean MADRS scores was large in both groups, reaching after 8 weeks of treatment mean scores of 9.1 in the mirtazapine group and 8.9 in the citalopram group. Both treatments also resulted in a substantial improvement in anxiety symptoms, sleep disturbances and quality of life, and high percentage of responders. However, at day 14, statistically significantly larger magnitudes of change favouring mirtazapine were present in the group mean MADRS, HAM-A and CGI-Severity of illness and Quality of life scores. A difference of 2.3 points on MADRS favouring mirtazapine is considered indicative for a clinically relevant superiority between two proven antidepressants. Mirtazapine treatment was also related to faster improvement of sleep, quality of sleep and improved alertness following awakening, as shown by statistically significant differences on the self-rating LSEQ at various time points. There were no differences between two treatment groups on self-rating QLSEQ. Both drugs were well tolerated, with a low number of patients in either group prematurely terminating the study due to adverse events (mirtazapine: 3.6%, citalopram, 3.0%). Sweating and nausea were statistically significantly more frequent in the citalopram group and increased appetite and complaints of weight increase in the mirtazapine group. There were no clinically relevant changes in laboratory parameters and vital sign variables with either treatment, except for clinically relevant increase in body weight, occurring more frequently in mirtazapine patients. In this study, mirtazapine and citalopram were equally effective in reducing symptoms of depression and anxiety, and well tolerated. However, mirtazapine was significantly more effective than citalopram after 2 weeks of treatment on the MADRS, HAM-A and CGI Severity of illness and Quality of life scales. This finding, consistently present at all major efficacy variables, suggests potentially faster onset of efficacy of mirtazapine over citalopram.

[Exposure therapy of phobic and compulsive disorders]. / Behandling av fobi og tvangslidelse med eksponeringsterapi.

Several methods have been used to treat anxiety disorder. In phobic conditions and in obsessive compulsive disorders, exposure therapy is most effective. In exposure therapy, the relevant evoking stimuli are presented repeatedly to the patient. This method does not suit all patients, however. For favourable results, certain exclusion criteria must be observed. In addition, the treatment procedure must be followed systematically.