Help Available for Depression Triggered by Interferon
Antidepressants Make This Cancer, Hepatitis C Therapy
By L.A. McKeown
WebMD Medical News
Reviewed by Dr. Jacqueline Brooks
March 29, 2001 -- For some people with hepatitis,
certain cancers, and multiple sclerosis, drugs
designed to extend life also can spoil its quality.
Interferon alpha, a drug used to fight these diseases,
can cause a crippling depression. New research now
shows that taking an antidepressant for a few weeks,
before starting treatment, can reduce this likelihood.
When people with the skin cancer malignant melanoma
were given the antidepressant Paxil for two weeks
before they started chemotherapy with high-dose
interferon, only 11% developed depression compared
with 45% of those who did not receive Paxil before
Depression associated with high doses of interferon is
very common, but patients shouldn't have to suffer
through it or accept it as part of their treatment.
Andrew H. Miller, MD, of the department of psychiatry
and behavioral sciences at Emory University School of
Medicine in Atlanta, says doctors have assumed for
years that depression associated with cancer is
psychological. But his small study of 40 patients is
further proof that the therapies themselves can induce
"About 33% of patients who started on the interferon
had to stop because the depression was so severe,"
says Miller, lead author of the research, which
appears in the March 29 issue of The New England
Journal of Medicine. "We tend to ... have patients
grin and bear it. We also have a tendency to expect
people to be depressed because they have cancer."
The good news, he says, is Paxil and other
antidepressants not only help alleviate the depression
that could cause people to stop treatment, but also
help in other ways. Study participants who took Paxil
before undergoing 12 weeks of interferon treatment
reported less pain and fewer stomach problems. They
also reported less confusion, distractibility, or
memory problems and slightly less fatigue than people
who didn't get the antidepressants.
"I think patients should be aware of this, and they
should think long and hard about whether they want to
take advantage of a treatment that may keep them in a
state where they will still feel like being with
family and friends and still functioning at some level
while [undergoing therapy]," Miller says. "Depression
is not just sadness. People can become irritable --
they become difficult, ... that can cause tension
within the family."
Meenhard Herlyn, DSci, of Philadelphia's Wistar
Institute, says that more patients might agree to take
high-dose interferon therapy if it could be made less
"Anything you can do to reduce the side effects of
interferon would be a big help," Herlyn says. "Many
people have to stop the treatment because they can't
People with hepatitis C also are treated with
interferon infusions combined with the drug Virazole.
Though it's likely that many of these patients become
depressed from interferon, few studies have documented
how widespread the problem may be. The CDC says nearly
4 million Americans are infected with hepatitis C, a
liver disease transmitted from one person to another
through exposure to blood or blood products.
Miller's next study will look at whether Paxil can
reduce depression among hepatitis C patients. So far,
it seems to be working, he says.
Hepatitis C expert Adrian M. Di Bisceglie, MD, tells
WebMD he gives antidepressants to patients on
interferon therapy at the first sign of a problem. If
patients have a history of depression or have
experienced depression once before while on
interferon, he gives antidepressants before interferon
"We started doing this without [research to support
it], though," says Di Bisceglie, a professor of
internal medicine and chief of hepatology at St. Louis
University School of Medicine in Missouri. "It's good
to get some science injected into this." But he says
the study does not mean that everyone who receives
interferon needs to be pretreated with
While it looks as though Paxil has a similar potential
to reduce depression in hepatitis C patients, the drug
has sexual side effects that could become an issue for
people living with a chronic disease like hepatitis
than for those trying to get through cancer treatment.
"It hasn't come up as yet, but it might, and then, of
course, we might think about using other
antidepressants that might have a little bit better
profile as far as sexual function," Miller says.
Do You Yahoo!?
Get email at your own domain with Yahoo! Mail.