Because interferon alfa is a crucial treatment for many patients with malignant melanoma, it is important that they receive the full course of medication. However, it often causes harsh side effects, including major depression in some patients, which can cause them to drop out of interferon therapy.

In the first study to date to look at use of antidepressants before interferon alfa therapy, David Lawson, MD, and colleagues at Emory University studied 40 patients with malignant melanoma who had undergone surgery and were eligible for high-dose interferon treatment.

Two weeks before starting interferon treatments, half the patients began taking paroxetine and half began taking a placebo. Patients were randomly assigned to each group, and neither the patients nor the researchers knew who was receiving the actual treatment until the end of the study.

Researchers initiated early treatment with paroxetine because it has been established that paroxetine and similar antidepressants do not take effect until about two weeks after treatment begins.

Using both self-report questionnaires and interviews, researchers examined the degree of depression in each group of patients before and during interferon treatment. Patients were assessed for symptoms of major depression, such as low mood, fatigue, sleep disturbances, impaired concentration, and suicidal thoughts.

Paroxetine appeared to significantly minimize depression in patients receiving interferon. Only 11% of the patients receiving paroxetine showed symptoms of severe depression, while 45% of patients receiving the placebo showed such symptoms.

In addition, patients taking paroxetine were more likely to continue interferon treatments for the full 12 weeks of the study. Only one of 20 patients receiving paroxetine (5%) discontinued interferon treatments due to severe depression, compared with 7 of 20 patients (35%) in the placebo group.

This study represents an important advance in the quality of care for melanoma patients, says Martin Weinstock, chair of the American Cancer Society skin cancer advisory group and professor of dermatology at Brown University. "As we advance in our treatment of cancer, it becomes important to try to ameliorate the side effects of the treatments," he says. "This is an area of research that will become more and more prominent, and this study makes a worthwhile contribution," says Weinstock.

"We still have some improvements to make," says Lawson. "Is paroxetine really the best antidepressant? It may be that another class of agents would be better, or that you could use two classes of antidepressants and do even better. This is worth examining," he says.

Lawson nonetheless urged patients who are facing interferon treatment to seriously discuss taking paroxetine beginning a couple of weeks before starting interferon therapy with their doctors. "If they?re discouraged about the depression and fatigue they might have heard about, they should be aware that these symptoms don?t have to be as severe as in the past. [Paroxetine] might make this treatment more tolerable for more patients."