Early prediction of major depression in chronic hepatitis C patients during peg-interferon α-2b treatment by assessment of vegetative-depressive symptoms after four weeks

Abstract

sensitivity at a cut-point of > 15/35 was 95% (95% CI: 74-100). The positive predictive value equalled 44% (95% CI: 29-60). CONCLUSION:In this group of Belgian CHC patients infected after substance use, antiviral treatment caused a considerable risk of depression. Seven vegetativedepressive symptoms of the Zung scale at wk 4 of treatment predicted 95% of all emerging depressions, at a price of 56% false positive test results. INTRODUCTIONFollowing the recent expert consensus, patients with chronic hepatitis C (CHC) should now receive interferon (IFN) and ribavirin regardless of psychiatric status, except in uncontrolled psychiatric disease [1][2][3] . As 23%-44% of patients treated with IFN develop depressive symptoms during treatment [4,5] and since, more patients are treated, interferon-induced psychiatric illness is likely to become an increasingly important clinical problem [4,[6][7][8][9][10][11][12][13][14] . IFN-induced depression appears to be a depressive disorder that is unusually responsive to antidepressant treatment. Approximately 80% of patients are responsive within 4 wk [15] . This high response rate may be related to the usually short duration of this illness when treatment is initiated, to the mild to moderate severity of illness in most cases [1] , but also to the mainly interferon-induced influences on the central nervous system [16] . Based on the results of a small scale study (n = 16), it has been hypothesised that vegetative symptoms are Abstract AIM: To study the predictive value of the vegetativedepressive symptoms of the Zung Depression Rating Scale for the occurrence of depression during treatment with peg-interferon α-2b of chronic hepatitis C (CHC) patients. METHODS:T h e pre dic t ive value of ve ge t at ivedepressive symptoms at 4 wk of treatment for the o c c u r r e n c e o f a s u b s e q u e n t d i a g n o s i s o f m a j o r depressive disorder (MDD) was studied in CHC patients infected after substance use in a prospective, multicenter treatment trial in Belgium. The presence of vegetative-depressive symptoms was assessed using the Zung Scale before and 4 wk after the start of antiviral treatment. RESULTS:Out of 49 eligible patients, 19 (39%) developed MDD. The area under the ROC curve of the vegetative Zung subscale was 0.73, P = 0.004. The

Risk factors for the development of depression in patients with hepatitis C taking interferon-α

“…Robaeys et al116 found that vegetative-depressive symptoms at week 4 of treatment were predictive of a subsequent diagnosis of MDD; however, there were no differences between groups at baseline. Likewise, decreased motor speed was associated with increased symptoms of depression and fatigue 134…”

“…However, it is not clear whether this observed dose effect also holds for the development of depression (see Table 4). In general, rates of depression in patients taking IFN-α for HCV vary from 0%109,118 to up to 50% 21,62,97,99–101,104,108,113,116. Oncology patients taking up to five times the dose of IFN-α than those patients infected with HCV are prescribed have similar rates of depression from 5%119 up to 50% 120.…”

Is Depression an Inflammatory Disorder?

“…Remarkably, individuals who respond with enhanced corticotropin-releasing hormone and p38 mitogen-activated protein kinase responses within 12 h of a first infusion or injection are significantly more likely to develop clinically relevant depressive symptoms 1 or 2 months later in the midst of IFN-α treatment [67•, 68]. On a symptomatic level, people who respond to a first dose with increased sickness-type symptoms are far more likely to meet full criteria for MDD (including profound emotional distress) by 8 weeks of IFN-α therapy [69, 70]. Also as shown in Fig.…”

Depression: an inflammatory illness?: Figure 1

“…This consist of behavioural changes, including disturbance in sleep, appetite, psychomotor slowing, memory impairment and behaviour, that are thought to be very similar to biological symptoms of depression in humans 67 68. Interferon therapy is associated with sickness-like symptoms, including lack of sleep, loss of appetite, weight loss and fatigue, usually occurring during the first 2–4 weeks of therapy, that can be early indicators of depression which usually develops 1–3 months after treatment 69 70. Capuron et al found that in spite of considerable overlap in symptoms between cytokine induced depression and idiopathic depression in medically healthy subjects, psychomotor symptoms were much greater in the cytokine induced MDD group while cognitive distortions were greater in those with idiopathic MDD.…”