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Help Available for Depression Triggered by Interferon

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    Help Available for Depression Triggered by Interferon Antidepressants Make This Cancer, Hepatitis C Therapy More Bearable By L.A. McKeown WebMD Medical News
    Message 1 of 1 , Apr 16, 2001
      Help Available for Depression Triggered by Interferon

      Antidepressants Make This Cancer, Hepatitis C Therapy
      More Bearable

      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
      interferon therapy.

      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
      physically difficult.

      "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
      handle it."

      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.

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