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By Suzanne Rostler
NEW YORK, Mar 29 (Reuters Health) - The antidepressant paroxetine (Paxil) can help prevent anxiety in skin cancer patients and reduce the physical distress that can be caused by a drug used to treat their disease, study findings suggest.
In a study of 40 people with the rare, but deadly, form of skin cancer known as malignant melanoma, investigators found that patients who received the antidepressant drug 2 weeks before beginning treatment with interferon alfa experienced less pain and anxiety 3 months into their therapy than patients who took an inactive placebo pill.
Interferon alfa has been shown to improve survival in patients with melanoma, but it may also cause severe depression and is associated with extreme fatigue and impaired memory and concentration, according to Dr. Andrew H. Miller and colleagues from Emory University in Atlanta, Georgia.
"Given the high incidence of major depression in patients receiving interferon alfa for malignant melanoma, and the association between depression and the discontinuation of treatment, there appears to be justification for treating these patients with paroxetine," Miller's team writes.
Paroxetine is one of a class of drugs known as selective serotonin-reuptake inhibitors, which affect levels of the brain chemical serotonin. In an interview with Reuters Health, Miller noted that any of these drugs should have the same effect as paroxetine.
"There is no reason to believe that other drugs that affect the serotonin system would not be effective in reducing the emotional and physical distress associated with interferon alpha," Miller said.
According to the report in the March 29th issue of The New England Journal of Medicine, 45% of the patients who received the placebo became severely depressed, compared with only 11% of the patients who received the antidepressant. More than one third of patients in the placebo group stopped cancer treatment due to severe depression or other side effects. The drug did not appear to significantly improve fatigue, however.
The study was funded by Schering-Plough Pharmaceuticals, which manufactures interferon alpha, and SmithKline Beecham, which manufactures paroxetine under the brand name Paxil.
The authors recommend screening patients for symptoms of anxiety and depression before recommending interferon alfa therapy, to identify patients at risk for side effects.
Interferon alpha is also used to treat adult leukemia, certain kidney cancers, and hepatitis B and C. But it is too soon to recommend that patients undergoing interferon therapy for any of these disorders also take antidepressants, the researchers note.
SOURCE: The New England Journal of Medicine 2001;344:961-966.
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