Correspondence
Paroxetine for the Prevention of Depression Induced by Interferon Alfa
N Engl J Med 2001; 345:375-376August 2, 2001
- Article
To the Editor:
Musselman et al. (March 29 issue)1 suggest that prophylactic treatment with paroxetine is an effective strategy for minimizing depression induced by treatment with interferon alfa in patients with malignant melanoma. However, this strategy would require unnecessary antidepressant therapy in a large number of patients.
We have prospectively monitored patients with chronic hepatitis C during therapy with interferon alfa-2b (3 million to 5 million IU given three times a week), using repeated psychometric testing and psychological interviews to assess the psychiatric side effects of interferon alfa-2b. Clinically evident depression (according to the criteria of the International Classification of Diseases, 10th Revision, and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition) developed in 10 of 105 patients (8 women and 2 men; age range, 27 to 52 years). None had had depression before they received interferon alfa-2b, and none had a history of psychiatric disease. These patients were treated with paroxetine (20 mg daily) while they continued to receive interferon alfa-2b. Within four weeks, the depression improved. Only one patient had to stop interferon therapy prematurely because of insufficient improvement in depression.
In concordance with the findings of Musselman et al., our data suggest that concomitant therapy with paroxetine is an effective way to treat depression induced by interferon alfa-2b. However, we believe that starting antidepressive therapy only after interferon-induced depression has developed is a better strategy than prophylactic treatment. With this approach, many patients do not have to take an unnecessary antidepressant medication.
1 ReferencesMichael Rupert Kraus, M.D., Ph.D.
Arne Schäfer, M.Psych.
Michael Scheurlen, M.D.
University of Würzburg, 97070 Würzburg, Germany
m.kraus@mail. uni-wuerzburg. de 1
Musselman DL ,Lawson DH ,Gumnick JF , et al. Paroxetine for the prevention of depression induced by high-dose interferon alfa. N Engl J Med 2001;344:961-966
Full Text | Web of Science | Medline
Author/Editor Response
The authors reply:
To the Editor: We appreciate the concern about potentially “unnecessary” exposure of patients to paroxetine. Nevertheless, paroxetine prophylaxis should be considered an important strategy for managing psychiatric complications of interferon alfa-2b, especially in patients with malignant melanoma. Patients receiving interferon alfa-2b for malignant melanoma have a higher risk of major depression than do patients being treated with this agent for chronic hepatitis C (45 percent vs. 9.5 to 37.3 percent), probably because of the higher doses given for malignant melanoma.1,2 In addition, even though intensive monitoring of psychiatric symptoms with the use of standardized psychiatric assessments may be ideal, preventive strategies obviate a reliance on early detection and treatment by personnel who may have limited psychiatric training and time.
Once patients become depressed, they may opt to discontinue interferon therapy altogether, despite the availability of antidepressant treatment. Severe depression requiring the discontinuation of interferon therapy developed in seven patients in our placebo group; six of these patients (86 percent) never resumed treatment. Moreover, the risk of suicide among patients who become depressed cannot be underestimated. Finally, pretreatment with paroxetine not only reduced depression in our study, but also significantly reduced anxiety and neurotoxic effects. These data suggest that antidepressant prophylaxis addresses a wide range of neuropsychiatric complications of interferon therapy, making it much more tolerable.
2 ReferencesAndrew H. Miller, M.D.
Dominique L. Musselman, M.D.
Charles B. Nemeroff, M.D., Ph.D.
Emory University School of Medicine, Atlanta, GA 30322
amill02@emory.edu 1
Musselman DL ,Lawson DH ,Gumnick JF , et al. Paroxetine for the prevention of depression induced by high-dose interferon alfa. N Engl J Med 2001;344:961-966
Full Text | Web of Science | Medline2
Yates WR ,Gleason O . Hepatitis C and depression. Depress Anxiety 1998;7:188-193
CrossRef | Medline
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