A Biopsychosocial Model of Interferon-Alpha-Induced Depression in Patients with Chronic Hepatitis C Infection

Abstract

Background: The aim of this prospective study was to gain a more comprehensive picture of the biopsychosocial effects of interferon-α (IFN-α) treatment of patients with chronic hepatitis C (HCV). The predictors of depressive development and changes in health-related quality of life, life satisfaction and cognitive ability were measured with the inclusion of the social context. Furthermore, the effects of IFN-α treatment on indoleamine 2,3-dioxygenase, the level of tryptophan supply in the brain, the development of neurotoxic kynurenine metabolites and the thyroid glands were investigated. Therefore, for the first time the conditions for the development of depressive episodes in HCV patients treated with IFN-α were examined over the entire period of treatment as well as 3 months later, applying a holistic biopsychosocial model. Method: Psychiatric and biological assessments were carried out at 6 different times: before, during (at 1, 3, 6 and 9 months) and after the end of IFN-α treatment. Results: During IFN-α treatment 22 (53.7%) of 41 patients fulfilled the criteria for a treatment-related depressive disorder at least once during treatment. Contributing factors are tryptophan depletion (tryptophan to competing amino acids quotient), increased neurotoxic challenge (kynurenine to kynurenic acid quotient), less social support, female gender, preexisting psychiatric vulnerability, means of transmission, low financial security, impaired sexual satisfaction, small circle of friends, impaired physical role, strong body pain, low general health and vitality, reduced social functioning, impaired mental health and impaired emotional role. Conclusions: The awareness of relevant risk factors of IFN-α treatment-induced depression is essential to develop preventative treatment strategies.

Sexual dysfunction and dissatisfaction in chronic hepatitis C patients

“…This fi nding is similar to that observed in the general population 1,32,33 . Similarly, Baranyi et al suggested that impaired sexual satisfaction was a contributing factor to IFN-α-induced depression 41 . We found that impulsiveness was associated with SD.…”

Somatization Symptoms or Interferon-Related Adverse Events? Alexithymia and Somatization in Somatic Symptom Reporting of Patients with Chronic Hepatitis C

“…Current evidence shows that alexithymia is likely to affect health in many psychiatric [5] and medical disorders [6] and to modulate the onset and course of and the recovery from psychological and medical syndromes [5]. As somatic symptom reporting during the antiviral therapy might be at least in part accounted for by psychological factors [7], somatization and alexithymia may influence the patients' health status and induce clinicians to overtreat somatic symptoms or even decide to interrupt HCV treatment. We therefore aimed to investigate to which extent somatization and alexithymia are related to somatic symptom reporting (commonly referred to as somatic AEs) in CHC patients.…”

Incidence of Depression in Patients with Chronic Hepatitis C Receiving Combination Therapy of Pegylated Interferon-Alpha and Ribavirin

“…We read the article by Baranyi et al [1], in which the authors comprehensively evaluated the biopsychosocial effects of interferon-α (IFN-α) treatment in patients with chronic hepatitis C. The authors reported that more than half (53.7%) of patients fulfilled the criteria of depression at least once during the treatment and they identified many important psychosocial factors which contribute to the development of depression. We also conducted a prospective study to evaluate the incidence of depression in patients with hepatitis C virus (HCV) infection receiving combination therapy of pegylated IFN-α and ribavirin.…”