Fragoso Yara Dadalti, Frota Elizabeth Regina Comini, Lopes Juarez Silva, Noal Janaina Silveira, Giacomo Maria Cristina, Gomes Sidney, Gonçalves Marcus Vinicius Magno, da Gama Paulo Diniz, Finkelsztejn Alessandro
Universidade Metropolitana de Santos, São Paulo, Brazil.
Clin Neuropharmacol. 2010 Nov-Dec;33(6):312-6. doi: 10.1097/WNF.0b013e3181f8d513.
Interferon (IFN) beta is a safe and efficient drug for treating multiple sclerosis (MS). It is widely accepted that previously depressed patients may get worse when using IFN-beta. There are few reports on the association of IFN-beta and severe depression among patients without previous psychiatric history.
Discussion of a case of a patient with MS who developed severe depression and attempted suicide while using IFN-beta encouraged us to review the subject. A group of neurologists in Brazil retrospectively gathered together their similar cases for the present paper.
The present paper reports on 11 cases of severe depression with suicide attempts or ideation among patients with MS who were using IFN-beta. These patients had no previous history of any psychiatric disease. Nine patients developed the symptoms over a relatively short period (4 months, on average). Two patients developed severe depression after more than 1 year of treatment with IFN-beta. Phobic, aggressive, behavioral, psychotic, and manic symptoms also were observed in these patients, thus suggesting the existence of a complex mood-behavior disorder associated with this drug. Interferon beta withdrawal led to complete remission of symptoms. The Naranjo algorithm established a highly probable association between IFN-beta and this adverse reaction in these patients.
Although uncommon, severe depression with suicide ideation or attempts may be observed during treatment of MS with IFN-beta. This association should not discourage the use of this drug, but physicians need to be aware of this possible adverse event from IFN-beta.
干扰素（IFN）β是治疗多发性硬化症（MS）的一种安全有效的药物。普遍认为，既往有抑郁症的患者在使用IFN-β时病情可能会加重。关于IFN-β与无既往精神病史患者的严重抑郁症之间的关联，报道较少。
对一例使用IFN-β期间出现严重抑郁并企图自杀的MS患者的讨论促使我们对该主题进行回顾。巴西的一组神经科医生回顾性地收集了他们的类似病例以撰写本文。
本文报道了11例使用IFN-β的MS患者出现严重抑郁并伴有自杀企图或想法的病例。这些患者既往无任何精神疾病史。9例患者在相对较短的时间内（平均4个月）出现症状。2例患者在使用IFN-β治疗1年多后出现严重抑郁。这些患者还出现了恐惧、攻击、行为、精神病性和躁狂症状，因此提示存在与该药物相关的复杂情绪行为障碍。停用IFN-β后症状完全缓解。Naranjo算法确定IFN-β与这些患者的这种不良反应之间存在高度可能的关联。
虽然不常见，但在使用IFN-β治疗MS期间可能会观察到伴有自杀想法或企图的严重抑郁。这种关联不应阻碍该药物的使用，但医生需要意识到IFN-β可能导致的这种不良事件。
