Paroxetine Reduces Distress Associated With Cancer Treatment

According to a study conducted at EmoryUniversity, the prophylactic use of antidepressants is successful in preventing depression, anxiety, and physical distress in cancerpatients. The study, published in the New England Journal of Medicine(344:961-966, 2001), found that providing the antidepressant paroxetine (Paxil)2 weeks before beginning cancer treatment significantly reduced the developmentof clinical depression. In addition, the number of patients who had todiscontinue cancer treatment because of severe emotional or physical distresswas also reduced.

Andrew Miller, MD, professor, department of psychiatry andbehavioral sciences at Emory University School of Medicine, and his colleaguesat the Winship Cancer Institute and Rollins School of Public Health studied 40patients with malignant melanoma. Their objective was to prevent depression bytreating patients who were about to be given interferon-alpha, an agentpredominantly used to treat malignant disorders and infectious diseases.Although an effective therapy, interferon-alpha has been associated with highrates of central nervous system side effects, including the development ofsevere depression that in some instances has led to suicide.

Significant Prophylactic Effect

Patients were randomly assigned a placebo or paroxetine. Almost50% of patients who received the placebo became significantly depressed whilereceiving cancer treatment vs only about 10% in the paroxetine group.

"Patients who received the antidepressant also experiencedsignificantly less anxiety, fewer concentration and memory problems, and farless intense physical symptoms such as abdominal discomfort, pain, andfatigue," said Dr. Miller. "We wonder whether such an approach mayhave broader applications, including prevention of physical and emotionalcomplications of other cancer treatments and, possibly, even majorsurgery."

These data provide the first demonstration of the prophylacticuse of antidepressants in medically ill patients at high risk forneuropsychiatric disorders.