Interferon Alpha-Induced Depression in Chronic Hepatitis C Patients: Comparison between Different Types of Interferon Alpha

Abstract

IFN alpha treatment is able to produce dose-related side effects, such as depression, in the central nervous system. We assessed the effects on depression of four different types of IFN alpha (recombinant IFN alpha 2a, recombinant IFN alpha 2b, lymphoblastoid IFN alpha, leukocyte IFN alpha), administered at the same doses in four homogeneous groups of chronic hepatitis C patients (96 patients; 24 patients for each group). A group of 18 untreated hepatitis C patients was considered as a control group. Depression was measured using Zung’s self-rating depression scale (SDS scale) before starting IFN alpha therapy and at the 1st, 3rd and 6th month of treatment. In all patients evaluated, mean SDS values increased from mild to moderate depression, but never attained severe depression (SDS >70). More elevated SDS values were observed in the 1st month of treatment, with a progressive decrease during the end points above-mentioned. The recombinant IFN alpha 2a and lymphoblastoid IFN alpha arms presented higher SDS mean scores compared to the recombinant IFN alpha 2b and leukocyte IFN alpha arm. Only in the leukocyte IFN alpha arm SDS values returned to basal values at the 6-month end point. Leukocyte IFN alpha seemed to present a more elevated tolerability than other IFN alpha types available for clinical practice. A very careful selection of hepatitis C patients is required before starting IFN alpha therapy.

Depression following pegylated interferon-alpha: Characteristics and vulnerability

“…Thirty-nine percent of euthymic subjects developed MDD, consistent with a growing literature [3,7,, although this literature is complicated by retrospective, non-standardized diagnoses, and/or the present of active baseline mood disorder or antidepressants [23]. Notably, this study was specifically designed to prospectively assess IFN-α's effects while avoiding confounding biases from active neuropsychiatric illness and/or co-prescribed psychoactive medications.…”

“…However, exogenous interferon-α2 (IFN-α) can potentially trigger major depression (MDD) in a subset of patients [2][3][4] similar to idiopathic MDD [5][6][7][8].…”

Drug-Induced Depression: A Systematic Review to Inform Clinical Practice

“…One nonrandomized but controlled prospective study [90]reported significant elevations in depressive symptom ratings evaluated with the Zung scale. Malaguarnera et al [91]randomly assigned hepatitis C patients to three interferon-α treatment groups and a control group, evaluating mood state using the Zung scale. Higher ratings were observed in interferon-treated subjects.…”

5-Hydroxytryptophan plus SSRIs for interferon-induced depression: Synergistic mechanisms for normalizing synaptic serotonin

“…Other studies have reported a 27-35% incidence of depression among patients who have recently begun treatment involving IFN [8,9]. One study of 96 patients found that, after beginning IFN therapy, all of the patients developed or showed an increase in depressive symptoms [10]. It has been estimated that depression necessitates dose reduction in 40% of IFN-treated patients and that 15% of patients drop out of IFN treatment due to depression [11].…”