Emory researchers report new strategy to reduce emotional and physical distress associated with cancer treatment

A study conducted at Emory University was successful in preventing depression, anxiety and physical distress in cancer patients with the prophylactic use of antidepressants, the March 29 issue of New England Journal of Medicine reports.

Andrew Miller, M.D., professor, Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine, and Emory colleagues in the Department of Psychiatry and Behavioral Sciences, Winship Cancer Institute and Rollins School of Public Health, found in a study of 40 patients with malignant melanoma that providing the antidepressant paroxetine (Paxil) two weeks before beginning cancer treatment significantly reduced the development of clinical depression. Also reduced was the number of patients who had to discontinue cancer treatment because of severe emotional or physical distress.

The study�s objective was to prevent depression by treating patients who were about to be given Interferon (IFN)-alpha, an agent predominantly used to treat malignant disorders and infectious diseases. Although an effective therapy, IFN-alpha has been associated with high rates of central nervous system side effects, including the development of severe depression that in some instances has led to suicide. Patients were randomly assigned either a placebo or the paroxetine. Almost 50% of patients who got the placebo became significantly depressed while receiving the cancer treatment versus only about 10% in the group that received the antidepressant.

"Patients who received the antidepressant also experienced significantly less anxiety, less concentration and memory problems and far less intense physical symptoms such as abdominal discomfort, pain and fatigue, " said Dr. Miller. "We wonder whether such an approach may have broader applications, including prevention of physical and emotional complications of other cancer treatments and possibly even major surgery."

Pretreatment with paroxetine appears to represent an effective strategy for minimizing IFN-alpha-induced depression and neurotoxicity. In addition, these data provide the first demonstration of the prophylactic use of antidepressants in medically ill patients at high risk for neuropsychiatric disorders.

Other Emory investigators include Charles B. Nemeroff, M.D., Ph.D, Dominique L. Musselman, M.D., Jane F. Gumnick, M.D., Suzanne Penna, B.A., Rebecca Goodkin, B.A., Department of Psychiatry and Behavioral Sciences; David H. Lawson, M.D., Winship Cancer Institute; Amita Manatunga, Ph.D., Department of Biostatistics, Rollins School of Public Health.

National Institute of Mental Health (NIMH), Schering-Plough Pharmaceuticals and GlaxoSmithKline funded this study.