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Depression During Treatment With Interferon Alpha

TO THE EDITOR: The incidence and pathophysiology of depression during interferon alpha (IFN-) treatment is poorly understood. However, depression is one of the most frequent causes of early discontinuation of IFN- treatment. Recently Dieperink et al.¹ reported an incidence of depressive episodes of 23% during treatment of chronic hepatitis C with IFN-. The authors emphasized that higher depression scores before treatment were a risk factor for the development of depression during IFN- treatment.

Besides its use for the treatment of chronic hepatitis C, IFN- is also used for the adjuvant treatment of patients with malignant melanoma. We prospectively compared the development of depressive episodes in 45 patients with malignant melanoma before and during adjuvant treatment with IFN--2a or 2b (3x3 mio units/week). Mental changes were monitored with use of the Zung Self-Rating Depression Scale² before and after 1, 3, and 6 months of IFN- treatment. The patients were not taking antidepressants or other psychiatric medication.

Scores on the Zung Self-Rating Depression Scale increased significantly during treatment from baseline values of mean=38.2 (SD=9.1) to 45.4 (SD= 13.0) after 1 month (p=0.001, two-tailed t test), mean=43.7 (SD=11.5) after 3 months (p<0.001), and mean= 44.7 (SD=11.8) after 6 months (p< 0.001) compared to baseline. At baseline, 12% patient fulfilled criteria for a major depressive episode (index score >50). During adjuvant IFN- treatment, scores indicating depression (index score >50) were reached by 12 (31%) of 39 patients after 4 weeks, by 13 (40%) of 32 patients after 3 months, and by 12 (38%) of 31 patients after 6 months. Only three patients (6%) developed depression after the third month of treatment. Zung Self-Rating Depression Scale scores before treatment were positively correlated with scores after 1 month (r=0.65, p<0.001), 3 months (r=0.78, p<0.001), and 6 months (r=0.65, p<0.001).

We then compared patients with depressive Zung Self-Rating Depression Scale index scores >50 before IFN- treatment with nondepressed patients. Only three of six depressed patients had still depressive index scores after 4 weeks of IFN- treatment, four of four patients after 3 months, and three of four patients after 6 months. In contrast to nondepressed patients at baseline, the Zung Self-Rating Depression Scale scores of patients with depression did not increase significantly after 1, 3, and 6 months of IFN- treatment compared to baseline. Analysis with two-tailed Student's t tests showed significant differences between scores for the patients with and without depression before treatment (baseline) (t=–7.02, df=43, p<0.001) and 3 months after the start of treatment (t=–3.56, df=30, p=0.001). However, no differences were found after 1 and 6 months of treatment.

In conclusion, we can confirm an incidence of depression of 31% during 6 months of adjuvant IFN- treatment for malignant melanoma, with the highest self-rating scores occurring after 3 months of treatment. Besides the Beck Depression Inventory, the Zung Self-Rating Depression Scale is a useful instrument for monitoring depressive mood changes during IFN- treatment. However, our data do not support the view that patients with high depression scores before treatment generally have a higher risk of developing major depressive episodes during therapy with IFN-. This is in accordance with recent results showing that major depressive episodes did not occur more frequently in patients with severe psychiatric disorders during treatment with IFN- alone or in combination with ribavirin compared to patients without psychiatric disorders.^3–5

REFERENCES

1. Dieperink E, Ho SB, Thuras P, Willenbring ML: A prospective study of neuropsychiatric symptoms associated with interferon-alpha-2b and ribavirin therapy for patients with chronic hepatitis C. Psychosomatics 2003; 44:104–112[Abstract/Free Full Text]
2. Zung WWK: A self-rating depression scale. Arch Gen Psychiatry 1965; 12:63–70
3. Schaefer M, Schmidt F, Folwaczny C, Lorenz R, Martin G, Schindlbeck N, Heldwein W, Soyka M, Grunze H, Koenig A, Loeschke K: Adherence and mental side effects during hepatitis C treatment with interferon alfa and ribavirin in psychiatric risk groups. Hepatology 2003; 37:443–451[CrossRef][Medline]
4. Pariante CM, Landau S, Carpiniello B: Interferon alfa-induced adverse effects in patients with a psychiatric diagnosis. N Engl J Med 2002; 11:148–149
5. Pariante CM, Orru MG, Baita A, Farci MG, Carpiniello B: Treatment with interferon-alpha in patients with chronic hepatitis and mood or anxiety disorders. Lancet 1999; 10:131–132

Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Email this article to a Colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via Google Scholar Articles by Schaefer, M. Articles by Volkenandt, M. Search for Related Content PubMed Citation Articles by Schaefer, M. Articles by Volkenandt, M. Depression

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