Adjuvant therapy of melanoma with interferon-alpha-2b is associated with mania and bipolar syndromes

Abstract

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.

Cytokines and their Role in Health and Disease: A Brief Overview

“…Leukopenia, neutropenia and thrombocytopenia are other common side effects that can be readily managed via dose reduction. Central symptoms include mania in lower than 1%, confusion in 10%, and depression in 45% of patients during therapy [61][62][63]. Alterations of the immune system, which can be persisting even after discontinuation of the therapy, are also seen in few cases.…”

Neuropsychiatric Complications Associated with Interferon - Alpha -2b treatment of Malignant Melanoma

“…There have been case reports of mania occurring mostly within the context of abrupt withdrawal of Interferon therapy or especially after patients undergo significant dose reduction. 1 The current case report describes a case of a first episode of mania following planned dose reduction in a patient undergoing therapy with Interferon for malignant melanoma. This suggests a temporal association between the reduction of Interferon alpha and onset of the manic episode especially in the absence of a past psychiatric history.…”

“…Mania has been observed in patients undergoing interferon treatment especially after significant dosereduction or treatment breaks. 1 Malignant melanoma accounts for about 3% of all cancers. 2 Treatment for early stage malignant melanoma includes local excision, lymph node dissection.…”

“…1 As with most systemic treatment, it has some side effects which can be divided into constitutional, hematological , hepatic and neuropsychiatric effects. 1,4 Case history A 30 year old single male was diagnosed with malignant melanoma following discovery of a perineal mole. This was excised and found to be a nevoid spitzoid melanoma.…”

Bipolar Disorder and Cancer

“…[25] Siklosporin, flutamid, ifosfamid, interferon alfa, 5-fluorourasil, epirubisin ve siklofosfamid ile tedavi sürecinde mani geliştiğini aktaran çeşitli olgu bildirimleri bulunmaktadır. [26][27][28][29][30][31] …”