It is not uncommon that patient report of symptoms related to cytokine treatment may under- or over-represent the symptoms that might have been predicted based upon quantitative assessment. Many patients are alarmed at the potential consequences of dose reduction or treatment cessation if they complain of side effects, and thus may not report symptoms unless encouraged to do so. Conversely, some individuals are highly intolerant of even slight reductions in their cognitive efficiency.
Prior to initiating therapy, assessment for risk factors that might predispose the individual to develop depression should be performed, including assessment of the patient's past and family history of psychiatry illness and past history of neurologic disease. Potential side effects of cytokine treatment should be discussed with patients prior to initiating therapy. Patients should be regularly assessed for depression, including laboratory evaluations, neurologic functioning, and depression rating scales (Valentine et al., 1998).
The recent explosion in the elucidation of the mechanisms of cytokine-induced CNS effects has encouraged innovative trials of pharmacologic interventions, including antidepressants (Goldman, 1994; Levenson & Fallon, 1993), opiate antagonists, (Valentine, Meyers, & Talpaz, 1995), stimulants (Valentine et al., 1998), and corticosteroids (Amato et al., 1995). The synthetic steroid megestrol acetate may be an effective treatment for the anorexia and cachexia caused by cytokine treatment (Plata-Salaman, 1998). In the future it may be possible to specifically inhibit certain induced cytokines responsible for adverse side effects but maintain the therapeutic efficacy of the given cytokine (Taylor & Grossberg, 1998). Finally, non-pharmacologic approaches, including exercise and time management strategies, may be of benefit (Dalakas, Mock, & Hawkins, 1998). From these early experiences it is becoming clear that appropriate interventions will allow patients to continue on effective doses of cytokines for long periods of time.
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