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Adjuvant therapy of melanoma with interferon‐alpha‐2b is associated with mania and bipolar syndromes
Author(s) -
Greenberg Donna B.,
Jonasch Eric,
Gadd Michele A.,
Ryan Bonita F.,
Everett James R.,
Sober Arthur J.,
Mihm Martin A.,
Tanabe Kenneth K.,
Ott Mark,
Haluska Frank G.
Publication year - 2000
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(20000715)89:2<356::aid-cncr21>3.0.co;2-z
Subject(s) - mania , medicine , regimen , mood , alpha interferon , adjuvant therapy , bipolar disorder , mood stabilizer , oncology , psychiatry , cancer , interferon , immunology
BACKGROUND The use of a high dose regimen of interferon‐alpha‐2b (IFN) has recently been demonstrated to benefit patients with resected high risk melanoma. The incidence of melanoma is rising rapidly, and the use of this regimen is becoming increasingly common. IFN has been associated with numerous psychiatric side effects. METHODS The authors describe four melanoma patients treated with adjuvant IFN who developed a manic‐depressive syndrome or mood instability with therapy, and they review the literature on mania and the mixed affective syndromes associated with IFN. RESULTS The authors suggest that IFN may induce a mixed affective instability, and that patients risk developing hypomania or mania as IFN doses fluctuate or as IFN‐induced depression is treated with antidepressants alone. Mania is particularly associated with dose reductions or pauses in IFN treatment. The risk of mood fluctuation continues after treatment with IFN stops, and patients should be monitored for 6 months following completion of therapy. Gabapentin appeared effective as monotherapy for acute mania, as an antianxiety agent, as a hypnotic, and as a mood stabilizer in these individual cases. CONCLUSIONS Mania and mood instability can occur in patients being treated with IFN therapy for melanoma. In this study, gabapentin was an effective mood‐stabilizing agent for these patients. Cancer 2000;89:356–62. © 2000 American Cancer Society.