Depressive Mood Changes and Psychiatric Symptoms During 12-month Low-dose Interferon-α Treatment in Patients With Malignant Melanoma

Abstract

The purpose of the present study was to evaluate the incidence, spectrum and extent of psychiatric symptoms in patients with malignant melanoma (MM) before and during adjuvant treatment with interferon-alpha (IFN-alpha). 850 patients with cutaneous MM of > or =1.5 mm tumor thickness received standard low-dose IFN-alpha 2a in this prospective multicenter trial of the Dermatologic Cooperative Oncology Group (DeCOG). Psychiatric symptoms were evaluated at baseline and after 3, 6, and 12 months with the Beck Depression Inventory (BDI) and the Symptom Check List 90-Revised (SCL 90-R). In all, 282 patients completed all questionnaires. Mean BDI depression scores increased significantly during the first 6 months of IFN-alpha treatment (P < or =0.001), followed by a mild but not significant decrease. Also mean SCL 90-R scores increased significantly during the first 3 months of adjuvant treatment with IFN-alpha (P< or =0.001) and remained elevated until month 12 (P< or =0.001). Only 5% developed BDI scores >10, indicating a clinically significant depressive syndrome and only 1.4% reached a BDI score > or =18, indicating a moderate to severe depressive syndrome. Patients, who dropped-out early from psychiatric reasons, had significantly increased BDI and SCL-90R scores at baseline. Women scored higher in both scales before and during treatment if compared with men. In conclusion, adjuvant treatment with IFN-alpha was associated with a significant increase of BDI- and SCL 90-R scores. A higher pretreatment depression score was found to be a risk factor for an early drop-out during therapy. Pretreatment screening and an interdisciplinary care of the patients is recommended.

Social support decreases depressogenic effect of low-dose interferon alpha treatment in melanoma patients

“…Our results are in line with the findings of Heinze et al [26] who reported a delayed increase of depression scores during low-dose interferon alpha treatment. They also found that only a low number of participants (5%) reached the level for clinically relevant depressive syndrome during the treatment, similar to our study.…”

Mental Health Services Use by Melanoma Patients Receiving Adjuvant Interferon: Association of Pre-treatment Mental Health Care with Early Discontinuation

“…Our observation that patients with mental health services use before hd-ifn start were more likely to discontinue hd-ifn early is in keeping with findings from other ifn studies 18,19 . Capuron and Ravaud 19 observed a clear correlation between depression scores on treatment day 1 and at 4 weeks.…”

“…Capuron and Ravaud 19 observed a clear correlation between depression scores on treatment day 1 and at 4 weeks. In the Dermatologic Cooperative Oncology Group randomized trial of low-dose ifn for melanoma 18 , patients who had higher Beck Depression Inventory scores (≥5) before receiving ifn experienced increased odds, by a factor of 3, of early ifn discontinuation because of somatic or psychiatric effects (odds ratio: 3.09; 95% cl: 1.32, 7.27).…”

Depression: An Immuno-Inflammatory Cascade

“…It was found that the cytokines IFNα and IL2, used effectively as therapy for hepatitis C and cancer, Arşiv Kaynak Tarama Dergisi . Archives Medical Review Journal increase the risk for the development of depression 28,29 . Alterations in cytokine production have also been observed in animal models.…”