Mood Alterations During Interferon-Alfa Therapy in Patients With Chronic Hepatitis C: Evidence for an Overlap Between Manic/Hypomanic and Depressive Symptoms
J Clin Psychiatry 2005;66(8):1050-1057
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Psychiatric side effects are common
during interferon-alfa (IFN-alfa) therapy and often responsible
for early treatment discontinuation, thus limiting its
therapeutic potential. Depression is considered the hallmark of
these side effects. However, irritability, anger/hostility, and
manic/hypomanic episodes have also been reported, suggesting that
these symptoms are important features of IFN-alfa-induced
neuropsychiatric side effects.
Objective: The aim of this prospective study was
to use item-by-item analysis to thoroughly characterize
neuropsychiatric symptoms occurring during early IFN-alfa therapy
in a large cohort of patients with chronic hepatitis C.
Method: Ninety-three previously IFN-alfa-naive
patients treated with pegylated IFN-alfa plus ribavirin for
chronic hepatitis C were studied. Neuropsychiatric assessments
were conducted before initiation and after weeks 4 and 12 of
antiviral therapy. They included the Mini-International
Neuropsychiatric Interview, the 10-item Montgomery-Asberg
Depression Rating Scale, the State-Trait Anxiety Inventory, and
the Brief Fatigue Inventory.
Results: Psychiatric events occurred in 30
patients (32%). They consisted of mood disorders in all cases:
mania in 3 cases (10%), irritable hypomania in 15 cases (50%),
and depressive mixed states in 12 cases (40%). Neurovegetative
symptoms appeared within 4 weeks in most patients. In patients
who developed mood disorders, sadness and depressive thoughts
were present but minimal in severity. In contrast, inner tension
and anxiety symptoms increased significantly over time only in
Conclusions: Our results suggest that
IFN-alfa–induced mood disorders are common
and consist of an overlap between depressive and
manic symptoms rather than a mere depression.
The impact of such findings on therapeutic management
should be investigated.