Clinical Institute of Neuroscience, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.
J Clin Psychiatry. 2012 Aug;73(8):1128-38. doi: 10.4088/JCP.12r07694.
To carry out a systematic review of the risk factors for, and incidence of, major depressive episode (MDE) related to antiviral therapy for chronic hepatitis C.
The MEDLINE, PsycINFO, and Cochrane databases were searched to locate articles published from the earliest available online year until June 2011 using the keywords hepatitis C, interferon-alpha, peginterferon, pegylated interferon, depression, and mood and Boolean operators. Articles written in English, Spanish, and French were included.
Prospective studies reporting incidence of interferon-alpha-induced MDE were included. At baseline, patients did not present a DSM-IV/ICD depressive episode, and evaluation was performed by a trained clinician. Twenty-six observational studies met the inclusion criteria.
Extracted data included authors, year of publication, design, characteristics of the population, viral coinfection, adjunctive psychopharmacology, instruments to assess depression, dose and type of interferon-alpha, adjunctive ribavirin treatment, and follow-up time. Outcome of incidence of MDE (primary outcome measure) was abstracted, as were potential predictive variables.
A full review was performed. Meta-analysis of the cumulative incidence of induced MDE as a function of time was carried out. Odds ratios (ORs) and mean differences were used to estimate the strength of association of variables.
Overall cumulative incidence of depression was 0.25 (95% CI, 0.16 to 0.35) and 0.28 (95% CI, 0.17 to 0.42) at 24 and 48 weeks of treatment, respectively. According to our analysis, high baseline levels of interleukin 6 (mean difference = 1.81; 95% CI, 1.09 to 2.52), female gender (OR = 1.40; 95% CI, 1.02 to 1.91), history of MDE (OR = 3.96; 95% CI, 2.52 to 6.21), history of psychiatric disorder (OR = 3.18; 95% CI, 1.60 to 6.32), subthreshold depressive symptoms (mean difference = 0.96; 95% CI, 0.31 to 1.61), and low educational level (mean difference = -0.99; 95% CI, -1.59 to -0.39) were predictive variables of MDE during antiviral treatment.
One in 4 chronic hepatitis C patients who start interferon and ribavirin treatment will develop an induced major depressive episode. Clinicians should attempt a full evaluation of patients before starting antiviral treatment in order to identify those at risk of developing interferon-induced depression.
系统评价慢性丙型肝炎抗病毒治疗相关的重大抑郁发作（MDE）的危险因素和发生率。
使用关键词“丙型肝炎、干扰素-α、聚乙二醇干扰素、聚乙二醇干扰素、抑郁和情绪”，在 MEDLINE、PsycINFO 和 Cochrane 数据库中检索了从最早可在线获取的年份到 2011 年 6 月发表的文章，并使用布尔运算符进行搜索。纳入了英语、西班牙语和法语撰写的文章。
纳入了报告干扰素-α诱导的 MDE 发生率的前瞻性研究。在基线时，患者没有出现 DSM-IV/ICD 抑郁发作，并且由经过培训的临床医生进行评估。有 26 项观察性研究符合纳入标准。
提取的数据包括作者、发表年份、设计、人群特征、病毒合并感染、辅助精神药理学、评估抑郁的工具、干扰素-α的剂量和类型、辅助利巴韦林治疗以及随访时间。摘要了 MDE 发生率（主要结局指标）的结果，以及潜在的预测变量。
进行了全面审查。对诱导 MDE 的累积发生率作为时间函数进行了荟萃分析。使用优势比（ORs）和均数差值来估计变量关联的强度。
总的抑郁累积发生率分别为 24 周和 48 周时的 0.25（95% CI，0.16 至 0.35）和 0.28（95% CI，0.17 至 0.42）。根据我们的分析，较高的基线白细胞介素 6 水平（均数差值=1.81；95% CI，1.09 至 2.52）、女性（OR=1.40；95% CI，1.02 至 1.91）、MDE 病史（OR=3.96；95% CI，2.52 至 6.21）、精神障碍病史（OR=3.18；95% CI，1.60 至 6.32）、亚临床抑郁症状（均数差值=0.96；95% CI，0.31 至 1.61）和较低的教育水平（均数差值=-0.99；95% CI，-1.59 至-0.39）是抗病毒治疗期间 MDE 的预测变量。
开始干扰素和利巴韦林治疗的慢性丙型肝炎患者中，每 4 人就有 1 人会出现诱导性重度抑郁发作。临床医生应在开始抗病毒治疗前对患者进行全面评估，以识别出有发生干扰素诱导性抑郁风险的患者。
