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Paroxetine Does Not Improve Fatigue in Cancer Patients Rreceiving Chemotherapy

While paroxetine does improve depression and general mood in patients with cancer who are undergoing chemotherapy, it does not significantly relieve symptoms of fatigue, according to a randomised clinical trial.

Fatigue is a common side effect of chemotherapy; though, little is known regarding the aetiology of fatigue. Since fatigue and depression coexist in many cancer patients, it has been proposed that these conditions share a common mechanism, possibly through the serotonin pathway. Whether antidepressant therapy also aids in the treatment of chemotherapy-related fatigue has not been investigated.

Gary R. Morrow, PhD, and colleagues at the University of Rochester Cancer Center, New York, United States, evaluated the use of the selective serotonin reuptake inhibitor (SSRI) antidepressant paroxetine in the treatment of fatigue in cancer patients.

The study included 549 cancer patients who experienced fatigue after undergoing 2 cycles of chemotherapy. Patients were randomised to receive either oral paroxetine hydrochloride (20 mg/day) or placebo for 8 weeks. Fatigue and depression were assessed after cycles 2, 3, and 4.

"Paroxetine had neither beneficial nor detrimental effects on fatigue," noted the authors. However, paroxetine did significantly decrease the mean level of depression, "providing evidence that the dose selected had biologic activity."

Depression decreased by 18.9% in the paroxetine-treated group and by 6.3% in the placebo group, as determined by the total Center for Epidemiologic Studies Depression (CES-D) scores. Moreover, improvement in depression was evident as of the third cycle of chemotherapy.

Paroxetine treatment also had favourable effects on the patients' general psychological mood.

A subgroup analysis indicated that paroxetine was ineffective at improving fatigue in both depressed and non-depressed patients.

These findings also suggest that "depression and fatigue are differentially affected by an SSRI known to modulate brain 5-hydroxytryptamine (5-HT) levels," and therefore do not likely share a final common neural pathway involving serotonin.
J Clin Oncol. 2003 Dec 15;21:24:4635-4641. "Differential effects of paroxetine on fatigue and depression: a randomized, double-blind trial from the university of Rochester cancer center community clinical oncology program"

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