FREQUENCY OF DEPRESSION AND SOMATIC SYMPTOMS IN PATIENTS ON INTERFERON ALPHA/RIBAVIRIN FOR CHRONIC HEPATITIS C
Abstract
Background: Large numbers of patients suffering from Chronic Hepatitis C (HCV) are seekingtreatment with interferon alpha (IFN) because of significant advances in overall improvement inthe course of HCV and its complications. Objectives were to estimate the frequency of depressionand somatic symptoms in patients on interferon alpha/ribavirin treatment for chronic hepatitis C.Methods: It was an observational study conducted in the out-patient Department ofGastroenterology Shaikh Zayed Hospital, Lahore during a period of three months, i.e., fromSeptember to November 2008. One hundred consecutive patients undergoing interferon alpha/ribavirin treatment for chronic HCV were included in the study. All patients, irrespective of age,sex or duration of treatment were administered with a check list of common physical complaintsand DSM-IV symptoms for Major Depressive Episode. Results: Out of a total of 100 subjects 37were male and 63 were female. In all, 39 (39%) patients fulfilled the diagnostic criteria of DSMIV for Major Depressive Episode. Major Depression was more common in female 28 (44.4%) ascompared to male 11 (28.7%) patients. Somatic symptoms were common in all the patients butthey were reported more frequently by patients with Major Depression compared to those withoutMajor Depression. Myalgias, headache, joint pain, nausea/vomiting, abdominal pain andpalpitation were the most common physical symptoms. Conclusion: Major Depression andsomatic complaints are a common consequence of interferon alpha/ribavirin treatment for chronichepatitis C. All patients receiving this treatment should be periodically assessed for the detectionof these side effects to promptly address relevant treatment options.Keywords: Interferon Alpha, Ribavirin, Hepatitis C, DepressionReferences
Maddock C, Landau S, Barry K, Maulayah P, Hotopf M,
Cleare AJ, et al. Psychopathological symptoms during
interferon-alpha and ribavirin treatment: effects on virologic
response. Mol Psychiatry 2005;10:332–3.
Wichers MC, Koek GH, Robaeys G, Praamstra AJ, Maes M.
Early increase in vegetative symptoms predicts IFN-alphainduced cognitive-depressive changes. Psychol Med
;35:433–41.
Guadagnino V, Trotta MP, Carioti J, Caroleo B, Antinori A:
for the Nocchiero Study Group. Does depression
symptomatology affect medication compliance during the
J Ayub Med Coll Abbottabad 2010;22(4)
http://www.ayubmed.edu.pk/JAMC/PAST/22-4/Shakoor.pdf 9
first weeks of anti-HCV therapy in intravenous drug users?
Dig Liver Dis 2006;38:119–24.
McHutchison JG, Ware JE Jr, Bayliss MS, Pianko S,
Albrecht JK, Cort S, et al. The effects of interferon alpha-2b
in combination with ribavirin on health related quality of life
and work productivity. J Hepatol 2001;34:140–7.
Bernstein D, Kleinman L, Barker CM, Revicki DA, Green J.
Relationship of health-related quality of life to treatment
adherence and sustained response in chronic hepatitis C
patients. Hepatology 2002;35:704–8.
Dan AA, Martin LM, Crone C, Ong JP, Farmer DW, Wise T,
et al. Depression, anemia and health-related quality of life in
chronic hepatitis C. J Hepatol 2006;44:491–8.
Lisa AM, Mary FB, Bryan JM, Robert MV, Ravi L, Stanley
DR. Hepatitic C treatment for people with severe mental
illness. Psychomatics 2006;47:93–107
Raison CL, Borisov AS, Broadwell SD, Capuron L,
Woolwine BJ, Jacobson IM, et al. Depression during
pegylated interferon-alpha plus ribavirin therapy: prevalence
and prediction. J Clin Psychiatry 2005;66:41–8.
Manns MP, McHutchison JG, Gordon SC, Rustgi VK,
Shiffman M, Reindollar R, et al. Peginterferon alpha-2b plus
ribavirin compared with interferon alpha-2b plus ribavirin for
initial treatment of chronic hepatitis C: a randomised trial.
Lancet 2001; 358:958–65.
Fried MW, Shiffman ML, Reddy KR, Smith C, Marinos G,
Gonçales FL Jr, et al. Peginterferon alpha-2a plus ribavirin
for chronic hepatitis C virus infection. N Engl J Med
;347:975–82.
Bagheri H, Fouladi A, Barange K, Lapeyre-Mestre M, Payen
JL, Montastruc JL, et al. Follow-up of adverse drug reactions
from peginterferon alpha-2b-ribavirin therapy.
Pharmacotherapy 2004;24:1546–53.
Bonaccorso S, Marino V, Puzella A, Pasquini M, Biondi M,
Artini M, et al. Increased depressive ratings in patients with
hepatitis C receiving interferon alpha based immunotherapy
are related to interferon-alpha-induced changes in the
serotonergic system. J Clin Psychopharmacol 2002;22:86–90.
American Psychiatric Association. Diagnostic and Statistical
Manual of Mental Disorders, 4th Ed. Washington DC:
American Psychiatric Association; 1994.
Maddrey WC. Update in hepatology. Ann Intern Med
;134:216–23.
Malik IA, Khan SA, Tariq WUZ. Hepatitis C virus in
perspective; where do we stand. J Coll Physicians Surg Pak
;6:18.
Maddock C, Baita A, Orru MG, Sitzia R, Costa A, Muntoni
E, et al. Psychopharmacological treatment of depression,
anxiety, irritability and insomnia in patients receiving
interferon-alpha: a prospective case series and a discussion of
biological mechanisms. J Psychopharmacol 2004;18:41–6.
Rifai MA, Loftis JM, Hauser P. Interferon-alpha treatment of
patients with Hepatitis C: the role of a comprehensive riskbenefit assessment. CNS Drugs 2005;19:719–22.
Knott A, Dieperink E, Willenbring ML, Heit S, Durfee JM,
Wingert M, et al. Integrated psychiatric/medical care in a chronic
hepatitis C clinic: effect on antiviral treatment evaluation and
outcomes. Am J Gastroenterol 2006;101:2254–62.
Kraus MR, Schafer A, Faller H, Csef H, Scheurlen M..
Paroxetine for the treatment of interferon-alpha-induced
depression in chronic hepatitis C. Aliment Pharmacol Ther
;16:1091–9.
Horikawa N, Yamazaki T, Izumi N, Uchihara M. Incidence
and clinical course of major depression in patients with
chronic hepatitis type C undergoing interferon-alpha therapy:
a prospective study. Gen Hosp Psychiatry 2003;25:34–8.
Kraus MR, Schafer A, Faller H, Csef H, Scheurlen M.
Psychiatric symptoms in patients with chronic hepatitis C
receiving interferon alpha-2b therapy. J Clin Psychiatry
;64:708–14.
Published
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
