Asnis Gregory M, De La Garza Richard
Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Anxiety and Depression Program, Klau Basement, 111 E. 210th Street, Bronx, New York 10467, USA.
J Clin Gastroenterol. 2006 Apr;40(4):322-35. doi: 10.1097/01.mcg.0000210099.36500.fe.
Hepatitis C viral infection is a global health problem that affects approximately 4 million people in the United States. Combination treatment with pegylated interferon (IFN)-alpha plus ribavirin has been shown to be most effective in treating patients with chronic hepatitis C (CHC). Despite its efficacy, one of the most common side effects of this regimen is depression. Whereas IFN-alpha has been found to induce depression in chronic myelogenous leukemia, melanoma, and renal cell carcinoma, CHC patients may be especially prone to develop IFN-induced depression. This review includes a summary of differences between IFN-alpha and IFN-beta and addresses whether pegylation of IFN (versus nonpegylated IFN) gives rise to a treatment with reduced potential to induce depressive symptoms. Consideration is also given to evidence showing that treatment with ribavirin may contribute to IFN-induced depression. Thyroid disorders and anemia (as well as other medical conditions) have also been associated with IFN exposure and may account for some incidences of depression in CHC patients. Evidence is reviewed indicating that prior psychiatric and mood disorders (especially previous episodes of major depressive disorder), just prior to IFN treatment, contribute to the propensity to develop depression during treatment. In addition, a brief description is provided of potential biological mechanisms of IFN-induced depression (ie, monoamines, hypothalamic-pituitary-adrenocortical [HPA] axis, proinflammatory cytokines, peptidases, intercellular adhesion molecule-1, and nitric oxide). Finally, a discussion is provided on the use of antidepressants as a preventative versus restorative treatment, including a commentary on risks of using antidepressants in this patient population.
丙型肝炎病毒感染是一个全球性的健康问题，在美国约有400万人受其影响。聚乙二醇化干扰素（IFN）-α联合利巴韦林治疗已被证明是治疗慢性丙型肝炎（CHC）患者最有效的方法。尽管该疗法有效，但这种治疗方案最常见的副作用之一是抑郁症。虽然已发现IFN-α可在慢性粒细胞白血病、黑色素瘤和肾细胞癌患者中诱发抑郁症，但CHC患者可能特别容易发生IFN诱发的抑郁症。本综述总结了IFN-α和IFN-β之间的差异，并探讨了IFN的聚乙二醇化（与未聚乙二醇化的IFN相比）是否会导致诱导抑郁症状的可能性降低的治疗方法。还考虑了证据表明利巴韦林治疗可能导致IFN诱发的抑郁症。甲状腺疾病和贫血（以及其他疾病）也与IFN暴露有关，可能是CHC患者某些抑郁症发病的原因。综述的证据表明，在IFN治疗前存在的精神和情绪障碍（尤其是既往重度抑郁症发作）会增加治疗期间发生抑郁症的倾向。此外，还简要描述了IFN诱发抑郁症的潜在生物学机制（即单胺、下丘脑-垂体-肾上腺皮质[HPA]轴、促炎细胞因子、肽酶、细胞间黏附分子-1和一氧化氮）。最后，讨论了使用抗抑郁药作为预防性与恢复性治疗的问题，包括对在该患者群体中使用抗抑郁药风险的评论。
