The Relationship Between Alfa Interferon Treatment and
Depression
In addition to fatigue, nausea and other flu-like symptoms, one
of the potential side effects of alfa interferon treatment is
depression. Peter Hauser, M.D., is a professor of psychiatry and
internal medicine-endocrinology at the University of Maryland
School of Medicine and the head of psychiatry at Baltimore’s
VA Medical Center. He is conducting a study examining the side
effects depression and cognitive impairment, which are commonly
found with alfa interferon treatment, at the University of Maryland
School of Medicine. He answered our questions about alfa
interferon-induced depression.
Q. Is depression a common side effect of alfa interferon
treatment?
A. It is a side effect but there haven’t been any good
systematic studies examining the frequency of criterion-based major
depressive disorder, as opposed to the presence of some of the
symptoms of depression. Anecdotal studies suggest that
‘depression’ may be as common as 30 to 50 percent of
patients on alfa interferon.
Q. Can patients take antidepressants while on alfa interferon
treatment?
A. Certainly. There’s no reason why not. I think that some
physicians exclude patients from alfa interferon treatment if they
have significant symptoms of depression. I think it’s very
important to point out that we can treat depression before patients
start alfa interferon treatment and thereby give patients alfa
interferon, a potentially life-saving treatment.
Q. Should a patient stop alfa interferon treatment if he or she
is experiencing severe depression?
A. I think if a patient has severe symptoms of depression and
suicidal ideation then the initial step would be to reduce the dose
of alfa interferon. But, in severe cases of depression, the
medication should be stopped. If the physician prescribing alfa
interferon is working with a psychiatrist, and the patient is
willing to have antidepressant treatment, that should be
considered, particularly if the alfa interferon is considered a
life-saving treatment. But the patient should be very closely
monitored for a worsening of the depression.
Q. How can patients deal with alfa-interferon-induced
depression?
A. I believe that how a patient copes with alfa-interferon-induced
depression has much to do with the severity of the depression.
There are common side effects of alfa interferon treatment such as
fatigue, anorexia (the lack of any desire to eat), or loss of
energy that may be separate from the symptoms of depression.
Certainly fatigue alone can occur and other symptoms that you would
find in a fever-like state, [which] may feel like symptoms of
depression but may not be responsive to antidepressant medications.
Patients with fatigue as a symptom should consider rearranging
their work day or, if possible, reducing their workload during alfa
interferon treatment.
Q. Is screening for depression standard during alfa interferon
treatment?
A. It is not standard. I believe it’s very important to use
screening instruments and rating scales to measure depression in
patients that may be suspected of having major depression. I think
too that if the rating scales indicate [depressive symptoms] they
should subsequently have a psychiatric interview to establish the
diagnosis. If depressive symptoms are very mild, you can work with
patients to modify their activities such that if they are fatigued
they can take on a lighter workload or arrange their days so that
they are working during the part of the day when they are less
fatigued. For more severe depression, antidepressants can be
used.
Q. If depression is a side effect for someone on alfa interferon
treatment, how long can he or she expect the depression to
last?
A. Usually depression is medication-related so that once you stop
alfa interferon, the depressive symptoms will dissipate. However,
alfa interferon, at least in susceptible individuals -- people who
may have had previous episodes of depression -- may actually be a
precipitating factor to a depressive episode that will continue
once the medication has stopped.
Q. Should people with a history of depression communicate that
to their physicians before undergoing alfa interferon
treatment?
A. Certainly. [A history of depression] should not be something
that excludes them from life-saving treatment, but the physician
should then work in collaboration with a mental health professional
to monitor the patient for recurrence of depression and to treat
the patient if the depressive symptoms come back.
Exclusive to SHN.
Copyright © 1997 by Salu Communications, Inc. All rights
reserved.
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