Adjuvant therapy of melanoma with interferon-alpha-2b is associated with mania and bipolar syndromes - Gabapentin may serve as a mood stabilizer

BACKGROUND. The use of a high dose regimen of interferon-alpha-2b, (IFN) ha s recently been demonstrated to benefit patients with resected high risk me lanoma. The incidence of melanoma is rising rapidly, and the use of this re gimen is becoming increasingly common. IFN has been associated with numerou s psychiatric side effects. METHODS, The authors describe four melanoma patients treated with adjuvant IFN who developed a manic-depressive syndrome or mood instability with ther apy, and they review the literature on mania and the mixed affective syndro mes associated with IFN. RESULTS. The authors suggest that IFN may induce a mixed affective instabil ity, and that patients risk developing hypomania or mania as IFN doses fluc tuate or as IFN-induced depression is treated with antidepressants alone. M ania is particularly associated with dose reductions or pauses in IFN treat ment. The risk of mood fluctuation continues after treatment with IFN stops , and patients should be monitored for 6 months following completion of the rapy. Gabapentin appeared effective as monotherapy for acute mania, as an a ntianxiety agent, as a hypnotic, and as a mood stabilizer in these individu al cases. CONCLUSIONS. Mania and mood instability can occur in patients being treated with IFN therapy for melanoma. In this study, gabapentin was an effective moodstabilizing agent for these patients. (C) 2000 American Cancer Society.