psychiatrist

This work may not be copied, distributed, displayed, published, reproduced, transmitted, modified, posted, sold, licensed, or used for commercial purposes. By downloading this file, you are agreeing to the publisher’s Terms & Conditions.

Review Article

Interferon-Induced Depression in Chronic Hepatitis C: A Systematic Review and Meta-Analysis

Marc Udina, MD; Pere Castellví­, PhD; José Moreno-España, MD; Ricard Navinés, MD, PhD; Manuel Valdés, MD, PhD; Xavier Forns, MD, PhD; Klaus Langohr, PhD; Ricard Solí , MD, PhD; Eduard Vieta, MD, PhD; and Rocí­o Martí­n-Santos, MD, PhD

Published: August 15, 2012

Article Abstract

Objective: To carry out a systematic review of the risk factors for, and incidence of, major depressive episode (MDE) related to antiviral therapy for chronic hepatitis C.

Data Sources: The MEDLINE, PsycINFO, and Cochrane databases were searched to locate articles published from the earliest available online year until June 2011 using the keywords hepatitis C, interferon-alpha,peginterferon, pegylated interferon, depression, and mood and Boolean operators. Articles written in English, Spanish, and French were included.

Study Selection: Prospective studies reporting incidence of interferon-alpha-induced MDE were included. At baseline, patients did not present a DSM-IV/ICD depressive episode, and evaluation was performed by a trained clinician. Twenty-six observational studies met the inclusion criteria.

Data Extraction: Extracted data included authors, year of publication, design, characteristics of the population, viral coinfection, adjunctive psychopharmacology, instruments to assess depression, dose and type of interferon-alpha, adjunctive ribavirin treatment, and follow-up time. Outcome of incidence of MDE (primary outcome measure) was abstracted, as were potential predictive variables.

Data Synthesis: A full review was performed. Meta-analysis of the cumulative incidence of induced MDE as a function of time was carried out. Odds ratios (ORs) and mean differences were used to estimate the strength of association of variables.

Results: Overall cumulative incidence of depression was 0.25 (95% CI, 0.16 to 0.35) and 0.28 (95% CI, 0.17 to 0.42) at 24 and 48 weeks of treatment, respectively. According to our analysis, high baseline levels of interleukin 6 (mean difference=1.81; 95% CI, 1.09 to 2.52), female gender (OR=1.40; 95% CI, 1.02 to 1.91), history of MDE (OR=3.96; 95% CI, 2.52 to 6.21), history of psychiatric disorder (OR=3.18; 95% CI, 1.60 to 6.32), subthreshold depressive symptoms (mean difference=0.96; 95% CI, 0.31 to 1.61), and low educational level (mean difference=−0.99; 95% CI, -1.59 to −0.39) were predictive variables of MDE during antiviral treatment.

Conclusions: One in 4 chronic hepatitis C patients who start interferon and ribavirin treatment will develop an induced major depressive episode. Clinicians should attempt a full evaluation of patients before starting antiviral treatment in order to identify those at risk of developing interferon-induced depression.

J Clin Psychiatry 2012;73(8):1128-1138

 

 

Submitted: February 2, 2012; accepted March 28, 2012 (doi:10.4088/JCP.12r07694).

 

Corresponding author: Rocí­o Martí­n-Santos, MD, PhD, Clinical Institute of Neuroscience, Hospital Clí­nic, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain, Villarroel, 170, 08036-Barcelona ([email protected]).

Volume: 73

Quick Links:

Continue Reading…

Subscribe to read the entire article

$40.00

Buy this Article as a PDF

References