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