Elsevier

General Hospital Psychiatry

Volume 25, Issue 1, January–February 2003, Pages 34-38
General Hospital Psychiatry

Commentary and perspective
Incidence and clinical course of major depression in patients with chronic hepatitis type C undergoing interferon-alpha therapy: a prospective study

https://doi.org/10.1016/S0163-8343(02)00239-6Get rights and content

Abstract

This study examined the incidence, clinical course and its risk factors for major depression in patients with chronic hepatitis type C undergoing interferon-alpha therapy. Ninety-nine subjects underwent the psychiatric interviews for diagnosis of major depressive episode according to the DSM-IV criteria before the start of interferon therapy, and once every 4 weeks during both the 24-week treatment period and 12 weeks after the end of therapy. Depressive symptoms were also evaluated using the Hamilton Rating Scale for Depression. Major depression occurred during interferon therapy in 23 patients (23.2%). In 73.9% of them depression occurred within 8 weeks after the start of therapy. Twenty-two patients with depression completed the therapy and 59.1% of them achieved remission by the end of therapy with a mean duration of 11.6 weeks. Although the other 40.9% were not in remission at the end of therapy, they achieved remission within 12 weeks thereafter. The only risk factor for depression was advanced age. Depression occurs frequently among patients with hepatitis type C undergoing interferon-alpha therapy. Such patients require careful observation, and psychiatrists should be sufficiently aware of this significant psychiatric complication of interferon therapy.

Introduction

Interferon (IFN) is frequently used to treat a wide variety of illnesses, including viral hepatitis, several types of malignancy and multiple sclerosis. Psychiatric symptoms, especially depression, are one of the most significant complications of IFN therapy [1], [2]. These symptoms cause considerable distress to patients, and often necessitate discontinuation of the therapy [1], [2]. In extreme cases, such depression may lead to suicide or attempted suicide [3], [4], [5]. There have been some prospective follow-up studies assessing IFN-associated psychiatric symptoms [6], [7], [8], [9], [10], [11], [12], [13]. However, many of these have only used self-rating depression or anxiety scales. Although some previous studies have been based on psychiatric interviews [10], [12], [13], they often have methodological flaws, such as bias in patient selection [13] or a low frequency of follow-up examinations [10], [12], [13]. As a result, there is insufficient information about the clinical characteristics of these patients. For this reason we have carried out a prospective study on a large number of patients with chronic hepatitis type C undergoing IFN-alpha therapy, and investigated the incidence of depression during the treatment period, its clinical course and the risk factors for depression.

Section snippets

Subjects

From August 1996 to July 1997, 117 patients with chronic hepatitis type C started IFN-alpha therapy at the Musashino Red Cross Hospital, Tokyo. Hepatologists explained the significance and methods of this study to all of these patients and asked them to participate. One hundred ten of the patients agreed to participate, and gave written informed consent. Eleven patients, who had to discontinue IFN therapy because of physical complications including severe anorexia, vomiting, retinal hemorrhage

Results

No patients satisfied the criteria for major depression before IFN therapy, although depressive mood and/or anhedonia defined in the DSM-IV were seen in 8 (8.1%). Twenty-three patients (23.2%) were diagnosed as having major depression at least once during the 24-week treatment period. No manic episode, schizophrenic disorder, other psychotic disorders, or delirium occurred during the treatment period. In addition, no patients were diagnosed as having current substance-related disorders,

Discussion

The present study showed that the incidence of major depression in patients with chronic hepatitis type C undergoing IFN-alpha therapy was 23.2%. Some authors [10], [12] have previously reported a high incidence of depression during IFN therapy. Pariante [12] examined 50 patients with hepatitis type B or C treated with IFN-alpha for 12 months, and found that the incidence of DSM-III-R-defined major depression was 24.1%, excluding patients who had to discontinue IFN therapy because of physical

Conclusions

We have confirmed that major depression is a frequent occurrence among patients with hepatitis type C undergoing IFN-alpha therapy. Such patients require careful observation, and psychiatrists should be sufficiently aware of the incidence of depression, its clinical course, and associated risk factors.

References (41)

  • P. Malek-Ahmadi

    Mood disorders associated with interferon treatmenttheoretical, and practical considerations

    Ann Pharmacother

    (2001)
  • C. Borras et al.

    Emotional state of patients with relapsing-remitting MS treated with interferon beta-1b

    Neurology

    (1999)
  • A. Caraceni et al.

    Neurotoxicity of interferon-alpha in melanoma therapyresults from a randomized controlled trial

    Cancer

    (1998)
  • C.M. Hunt et al.

    Effect of interferon-alpha treatment of chronic hepatitis C on health-related quality of life

    Dig Dis Sci

    (1997)
  • H. Miyaoka et al.

    Depression from interferon therapy in patients with hepatitis C

    Am J Psychiatry

    (1999)
  • D.C. Mohr et al.

    Course of depression during the initiation of interferon beta-1a treatment for multiple sclerosis

    Arch Neurol

    (1999)
  • P.F. Renault et al.

    Psychiatric complications of long-term interferon alpha therapy

    Arch Intern Med

    (1987)
  • Diagnostic, and Statistical Manual of Mental Disorders

    (1994)
  • M. Hamilton

    A rating scale for depression

    J Neurol Neurosurg Psychiatry

    (1960)
  • G.E. Simon

    Long-term prognosis of depression in primary care

    Bull World Health Organ

    (2000)
  • Cited by (130)

    • The emerging tale of microglia in psychiatric disorders

      2021, Neuroscience and Biobehavioral Reviews
    • Somatic pain associated with initiation of interferon-alpha (IFN-α) plus ribavirin (RBV) therapy in chronic HCV patients: A prospective study

      2020, Brain, Behavior, and Immunity - Health
      Citation Excerpt :

      The peak of somatic pain scores at 8th week may imply the cumulative result of stress response to chronic pain and contributed to the higher incidence of depressive episodes in the first 8 weeks of our study. Similarly, previous literature also reported a higher depression incidence in the first 8 weeks in HCV patients receiving IFN-α therapy (Choi et al., 2017; Horikawa et al., 2003; Malaguarnera et al., 2001). Moreover, previous literature revealed a positive predictive effect of somatic pain, especially non-specific musculoskeletal complaints, on the occurrence of depression (Gerber et al., 1992).

    • Oxidative stress: a potential link between emotional wellbeing and immune response

      2016, Current Opinion in Pharmacology
      Citation Excerpt :

      And, exogenous administration of cytokines triggered depressive symptoms in human subjects. In fact, a dose–response relationship between interferon-alpha (IFN-α) administration and depression was observed, with a tapering baseline effect on mood following discontinuation [30–36]. And, mood deterioration was reported with endotoxin injections and with inflammatory cytokine vaccines [37,38].

    View all citing articles on Scopus
    View full text