A prospective study of the incidence and open-label treatment of interferon-induced major depressive disorder in patients with hepatitis C

Abstract

Interferon (IFN) therapy has been associated with the development of Major Depressive Disorder (MDD) when given to patients with hepatitis C (HCV). The incidence, time course, risk factors, and treatment of IFN-induced MDD are poorly understood. The objectives of the present study were to determine the incidence of IFN-induced MDD, as well as to determine the efficacy of open-label antidepressant treatment, in particular selective serotonin reuptake inhibitors (SSRIs) for IFN-induced MDD. Thirty-nine HCV patients on IFN therapy were monitored weekly using the Beck Depression Inventory (BDI). Those who became depressed were treated with citalopram, a SSRI antidepressant. Main outcome measures included the incidence of IFN-induced MDD, as well as response rates to antidepressants in those patients who developed IFN-induced MDD. Our results showed that 13 of 39 patients (33%) developed IFN-induced MDD. There were no differences in age, gender, past history of MDD, or substance use between those who became depressed and those who did not. However, there were significantly fewer African American patients in the depressed group. Patients who developed IFN-induced MDD were on IFN therapy for an average of 12.1 weeks prior to the development of MDD. Eleven of 13 patients (85%) were responsive to antidepressant treatment. We conclude that IFN-induced MDD is common in HCV patients. Health care providers should follow IFN-treated HCV patients for the development of MDD, particularly between the 2nd and 5th months of IFN therapy. SSRIs, in particular citalopram, are an effective treatment for IFN-induced depression in HCV patients.

Exploring drug users’ attitudes and decisions regarding hepatitis C (HCV) treatment in the U.S.

“…For example, drug users continue to face discrimination from some medical providers who frequently treat them with distrust and disrespect (Chitwood, Sanchez, Comerford, & McCoy, 2001;Crofts, Louie, & Loff, 1997;Day, Ross, & Dolan, 2003;Edlin et al, 2001;Stephenson, 2001;Treloar, Hopwood, & Loveday, 1996;Zickmund, Hillis, Barnett, Ippolito, & LaBrecque, 2004). Also, despite the recent changes to the NIH guidelines regarding HCV treatment, many health care providers have historically been concerned that drug users treated for HCV might have a high risk of re-infection, low treatment compliance, and/or drug relapse (Catz, Kelly, Bogart, Benotsch, & McAuliffe, 2000;Golub et al, 2004;Gordillo, del Amo, Soriano, & Gonzalez-Lahoz, 1999;Hauser et al, 2002;Milby et al, 1996;Osher et al, 2003). In fact, recent research conducted by Morrill et al (2005) found that primary care physicians tended not to treat patients with a past history of substance abuse for their HCV infection.…”

The immune-mediated alteration of serotonin and glutamate: towards an integrated view of depression

“…52,53 Side effects of cytokine therapies A depressive syndrome including suicidal ideations is a common side effect of cytokine administration, for example, IFN-a in the therapy of hepatitis C or malignant melanoma. [54][55][56][57][58] During these therapies, IDO is activated and the tryptophan metabolism increases. The psychopathological changes seem to be closely related to the tryptophan metabolism: patients developing more severe depressive symptoms during IFN-a showed a more pronounced increase in tryptophan metabolism.…”

IDO and interferon-α-induced depressive symptoms: a shift in hypothesis from tryptophan depletion to neurotoxicity

“…Recent clinical studies have shown that approximately 16-45% of patients treated with IFN-a developed depressive symptoms during the course of therapy. [1][2][3][4] Biological mechanisms underlying these IFN-a-induced depressive side effects are still not clear.…”