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Previous Volume 344:961-966 March 29, 2001 Number 13 Next

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ABSTRACT

Background Depression commonly complicates treatment with the cytokine interferon alfa-2b. Laboratory animals pretreated with antidepressants have less severe depression-like symptoms after the administration of a cytokine. We sought to determine whether a similar strategy would be effective in humans.

Methods In a double-blind study of 40 patients with malignant melanoma who were eligible for high-dose interferon alfa therapy, we randomly assigned 20 patients to receive the antidepressant paroxetine and 20 to receive placebo. The treatment was begun 2 weeks before the initiation of interferon alfa and continued for the first 12 weeks of interferon alfa therapy.

Results During the first 12 weeks of interferon alfa therapy, symptoms consistent with a diagnosis of major depression developed in 2 of 18 patients in the paroxetine group (11 percent) and 9 of 20 patients in the placebo group (45 percent) (relative risk, 0.24; 95 percent confidence interval, 0.08 to 0.93). Severe depression necessitated the discontinuation of interferon alfa before 12 weeks in 1 of the 20 patients in the paroxetine group (5 percent), as compared with 7 patients in the placebo group (35 percent) (relative risk, 0.14; 95 percent confidence interval, 0.05 to 0.85). The incidence of adverse events was similar in the two groups.

Conclusions In patients with malignant melanoma, pretreatment with paroxetine appears to be an effective strategy for minimizing depression induced by interferon alfa.

Source Information

From the Department of Psychiatry and Behavioral Sciences (D.L.M., J.F.G., S.P., R.S.G., C.B.N., A.H.M.) and the Winship Cancer Institute (D.H.L, K.G.), Emory University School of Medicine; and the Department of Biostatistics, Rollins School of Public Health, Emory University (A.K.M.) — both in Atlanta.

Address reprint requests to Dr. Miller at the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1639 Pierce Dr., Suite 4000, Atlanta, GA 30322, or at amill02{at}emory.edu.

Full Text of this Article

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Interferon Alfa–Induced Adverse Effects in Patients with a Psychiatric Diagnosis
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N Engl J Med 2002; 347:148-149, Jul 11, 2002. Correspondence

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