Depression During Pegylated Interferon-Alpha Plus Ribavirin Therapy: Prevalence and Prediction

J Clin Psychiatry. 2005 Jan;66(1):41-8. doi: 10.4088/jcp.v66n0106.

Abstract

Background: Interferon-alpha (IFN-alpha) plus ribavirin is used to treat hepatitis C virus (HCV) infection and is associated with a high rate of depression. Newer, pegylated preparations of IFN-alpha have a longer half-life, require once-per-week dosing, and may be associated with reduced neuropsychiatric burden. Limited data exist on depression during pegylated IFN-alpha therapy.

Method: Depressive symptoms were assessed using the Zung Self-Rating Depression Scale (SDS) in 162 HCV-infected patients at baseline and after 4, 8, 12, and 24 weeks of treatment with pegylated IFN alpha-2b (PEG IFN) plus weight-based (N = 86) versus standard dose (N = 76) ribavirin. Data were collected from March 2001 to April 2003.

Results: Compared with baseline, mean SDS index scores were significantly increased by week 4 and remained elevated throughout the study. Thirty-nine percent of the sample experienced moderate to severe depressive symptoms (SDS index score > or = 60) at some point during PEG IFN/ribavirin therapy. Baseline depression scores significantly predicted severity of depressive symptoms during PEG IFN/ribavirin treatment (simple regression analysis: Y = 0.55X + 32.7, p < .0001). In addition, assignment to weight-based ribavirin treatment and history of depression were associated with increased likelihood of developing moderate to severe depressive symptoms (odds ratio [OR] = 2.7, 95% CI = 1.3 to 5.6, p < .01, and OR = 3.3, 95% CI = 1.3 to 8.1, p < .01, respectively).

Conclusions: Development of moderate to severe depressive symptoms occurred frequently during PEG IFN/ribavirin treatment and was predicted by baseline depression scores and higher doses of ribavirin. History of major depressive disorder was also a significant predictive factor, but only through association with elevated baseline depression status. All of these factors can be evaluated and addressed to limit neuropsychiatric morbidity during HCV treatment.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Administration, Buccal
  • Adolescent
  • Adult
  • Aged
  • Antiviral Agents / adverse effects*
  • Antiviral Agents / therapeutic use
  • Cohort Studies
  • Depressive Disorder / chemically induced*
  • Depressive Disorder / diagnosis
  • Depressive Disorder / epidemiology
  • Dose-Response Relationship, Drug
  • Drug Carriers / adverse effects*
  • Female
  • Hepacivirus / drug effects
  • Hepatitis C / drug therapy*
  • Hepatitis C / virology
  • Humans
  • Interferon alpha-2
  • Interferon-alpha / adverse effects*
  • Interferon-alpha / therapeutic use
  • Male
  • Middle Aged
  • Personality Inventory
  • Polyethylene Glycols
  • Prevalence
  • Prospective Studies
  • Psychiatric Status Rating Scales
  • Recombinant Proteins
  • Ribavirin / adverse effects*
  • Ribavirin / therapeutic use
  • Risk Factors
  • Severity of Illness Index

Substances

  • Antiviral Agents
  • Drug Carriers
  • Interferon alpha-2
  • Interferon-alpha
  • Recombinant Proteins
  • Polyethylene Glycols
  • Ribavirin
  • peginterferon alfa-2b