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Effect of paroxetine on depression and insomnia in 547 fatigued cancer patients undergoing chemotherapy

Carolyn Vachani, RN, MSN, AOCN
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: June 23, 2008

Effect of paroxetine on depression and insomnia in 547 fatigued cancer patients undergoing chemotherapy

Depression and insomnia are two common issues in people with cancer. Studies have found that approximately 30% of people with cancer report insomnia and they are 2.5 times as likely to have insomnia compared with the general population. This study was carried out in order to determine the effectiveness of paroxetine in treatment of both depression and insomnia in patients undergoing treatment for cancer.

Patients were enrolled prior to beginning cancer treatment, and patient depression, insomnia, and fatigue levels were assessed at the time of each of the first four chemotherapy sessions. Following the second cycle of chemotherapy, 547 patients who reported cancer-related fatigue were randomized to receive paroxetine, 20 mg orally daily, versus placebo.

Patients randomized to paroxetine experienced significantly decreased rates of depression (p < 0.05) when compared to the control arm. A trend towards improvement in insomnia was noted in patients randomized to paroxetine, but this was not statistically significant. No impact on fatigue was seen in patients randomized to paroxetine versus those taking placebo. The researchers concluded that although the paroxetine improved depression, it did not improve insomnia or fatigue. This study is a well-designed trial that raises awareness of the need to consider insomnia as a separate entity from, and not an entity caused by, depression in cancer patients.