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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.

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