Advances in Clinical and Experimental Medicine

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Advances in Clinical and Experimental Medicine

2019, vol. 28, nr 9, September, p. 1217–1222

doi: 10.17219/acem/104617

Publication type: original article

Language: English

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Creative Commons BY-NC-ND 3.0 Open Access

Biological and psychological components of depression in patients receiving IFN-alpha therapy for hepatitis C

Krzysztof Małyszczak1,A,C,D,F, Małgorzata Inglot2,A,C,E,F, Dorota Frydecka1,A,C,E,F, Tomasz Hadryś1,C,D,E, Tomasz Pawłowski1,A,B,E,F

1 Department of Psychiatry, Wroclaw Medical University, Poland

2 Department of Infectious Diseases, Liver Diseases and Acquired Immune Deficiencies, Wroclaw Medical University, Poland

Abstract

Background. Depressive symptoms are frequent side effects of interferon α therapy (IFN-α). Both biological and psychological processes may occur concomitantly during hepatitis C treatment.
Objectives. This study was carried out to determine the impact of biological (immune response) and psychological factors on formation of depressive symptoms and major depressive disorder (MDD) during hepatitis C treatment.
Material and Methods. A total of 99 patients receiving pegylated IFN-α and ribavirin for chronic C type hepatitis participated in the prospective cohort study. Symptoms of depression were assessed with the MontgomeryÅsberg Depression Rating Scale (MADRS) during treatment and 24 weeks after treatment. Neuroticism was measured with the Eysenck Personality Questionnaire – Revised (EPQ-R/N). Diagnosis of MDD was made using the Present State Examination (PSE-10) and DSM-IV-TR criteria. Factor analysis was used to detect factors adding up to total severity of depressive symptoms. Predictors of MDD were investigated using logistic regression analysis.
Results. Factor analysis returned 3 factors: 1st – MADRS scores at weeks 0–12, 2nd – MADRS and N scores before treatment, 3rd – MADRS at the 24th week of treatment and 24 weeks after treatment. The total severity of depressive symptoms consisted of 3 components: personality-related before treatment, IFN-α-related during treatment and dependent on the effect of treatment. Regression analysis showed that a history of psychiatric disorders (OR = 4.8) and MADRS scores before treatment (OR = 1.25) were predictors of MDD, as opposed to level of neuroticism.
Conclusion. The severity of depressive symptoms and MDD during the hepatitis C treatment was related to general depressive vulnerability, not to psychological factors related to neuroticism.

Key words

depression, hepatitis C, interferon α, neuroticism trait

References (31)

  1. Myint AM, Schwarz MJ, Steinbusch HW, Leonard BE. Neuropsychiatric disorders related to interferon and interleukins treatment. Metab Brain Dis. 2009;24(1):55–68. doi:10.1007/s11011-008-9114-5
  2. Capuron L, Miller AH. Cytokines and psychopathology. Lessons from interferon-alpha. Biol Psychiatry. 2004;56(11):819–824. doi: 10.1016/j.biopsych.2004.02.009
  3. Raison CL, Capuron L, Miller AH. Cytokines sing the blues. Inflammation and the pathogenesis of depression. Trends Immunol. 2006;27(1):24–31. doi:10.1016/j.it.2005.11.006
  4. Raison CL, Borisov AS, Woolwine BJ, Massung B, Vogt G, Miller AH. Interferon-alpha effects on diurnal hypothalamic-pituitary-adrenal axis activity. Relationship with proinflammatory cytokines and behavior. Mol Psychiatry. 2010;15(5):535–547. doi:10.1038/mp.2008.58
  5. Dunn AJ, Wang J, Ando T. Effects of cytokines on cerebral neurotransmission. Comparison with the effects of stress. Adv Exp Med Biol. 1999;461:117–127. doi:10.1007/978-0-585-37970-8_8
  6. Felger JC, Miller AH. Cytokine effects on the basal ganglia and dopamine function: The subcortical source of inflammatory malaise. Front Neuroendocrinol. 2012;33(3):315–327. doi:10.1016/j.yfrne.2012.09.003
  7. Baranyi A, Meinitzer A, Breitenecker RJ, Ghadikolai OA, Stauber R, Rothenhäusler HB. Quinolinic acid responses during interferon-α-induced depressive symptomatology in patients with chronic hepatitis C infection: A novel aspect for depression and inflammatory hypothesis. PLoS One. 2015;10(9):e0137022. doi:10.1371/journal.pone.0137022
  8. Lotrich FE, Albusaysi S, Ferrell RE. Brain-derived neurotrophic factor serum levels and genotype: Association with depression during interferon-α treatment. Neuropsychopharmacology. 2013;38(6):985–995. doi:10.1038/npp.2012.263
  9. Udina M, Navinés R, Egmond E, et al. Glucocorticoid receptors, brain-derived neurotrophic factor, serotonin and dopamine neurotransmission are associated with interferon-induced depression. Int J Neuropsychopharmacol. 2016;19(4):1–12. doi:10.1093/ijnp/pyv135
  10. Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979;134:382–389.
  11. Mazurek J, Kiejna A, Małyszczak K, Stępień A. Assessment of depression scales reliability in the Polish population: The Bech-Rafaelsen Melancholia Scale, the Hamilton Depression Scale, and the Montgomery-Asberg Scale. Post Psychiatr Neurol. 1999;8(2):165–172.
  12. Wing JK, Babor TT, Brugha TT, et al. SCAN: Schedules for Clinical Assessment in Neuropsychiatry. Arch Gen Psychiatry. 1990;47(6):589–593. doi:10.1001/archpsyc.1990.01810180089012
  13. Kiejna A, Kallert TW, Rymaszewska J. Treatment in psychiatric day hospital in comparison with inpatient wards in different European health care systems – objectives of EDEN project. Psychiatr Pol. 2002;36(6 Suppl):361–367.
  14. Małyszczak K, Rymaszewska J, Hadryś T, Adamowski T, Kiejna A. Comparison between a SCAN diagnosis and a clinical diagnosis. Psychiatr Pol. 2002;36(Suppl 6):377–380.
  15. Adamowski T, Kiejna A, Hadryś T. Study of compatibility of psychiatric diagnoses with ICD-10 diagnostic criteria using the SCAN questionnaire. Psychiatr Pol. 2006;40(4):761–773.
  16. Eysenck HJ, Eysenck SBG. Manual of the Eysenck Personality Inventory. London, UK: Hodder & Stoughton; 1975.
  17. Kendler KS, Kuhn J, Prescott CA. The interrelationship of neuroticism, sex, and stressful life events in the prediction of episodes of major depression. Am J Psychiatry. 2004;161:631–636. doi:10.1176/appi.ajp.161.4.631
  18. Ormel J, Oldenhinkel AJ, Vollebergh W. Vulnerability before, during, and after a major depressive episode: A 3-wave population-based study. Arch Gen Psychiatry. 2004;61(10):990–996. doi:10.1001/archpsyc.61.10.990
  19. Brzozowski P, Drwal RŁ. Eysenck Personality Questionnaire, Polish adaptation of EPQ-R. Pracownia Testów Psychologicznych PTP, Warszawa, Poland; 1995.
  20. Sagen U, Vik TG, Moum T, Mørland T, Finset A, Dammen T. Screening for anxiety and depression after stroke: Comparison of the hospital anxiety and depression scale and the Montgomery and Asberg depression rating scale. J Psychosom Res. 2009;67(4):325–332. doi:10.1016/j.jpsychores.2009.03.007
  21. Jylhä P, Melartin T, Isometsä E. Relationships of neuroticism and extraversion with axis I and II comorbidity among patients with DSM-IV major depressive disorder. J Affect Disord. 2009;114(1–3):110–121. doi:10.1016/j.jad.2008.06.011
  22. Ormel J, Jeronimus BF, Kotov R, et al. Neuroticism and common mental disorders: Meaning and utility of a complex relationship. Clin Psychol Rev. 2013;33(5):686–697. doi:10.1016/j.cpr.2013.04.003
  23. Choi JS, Kim W, Sohn BK, et al. Association of changes in mood status and psychosocial well-being with depression during interferon-based treatment for hepatitis C. Psychiatry Investig. 2017;14(3):314–324. doi:10.4306/pi.2017.14.3.314
  24. Mahajan S, Avasthi A, Grover S, Chawla YK. Role of baseline depressive symptoms in the development of depressive episode in patients receiving antiviral therapy for hepatitis C infection. J Psychosom Res. 2014;77(2):109–115. doi:10.1016/j.jpsychores.2014.05.008
  25. Carta MG, Hardoy MC, Garofalo A, et al. Association of chronic hepatitis C with major depressive disorders: Irrespective of interferon-alpha therapy. Clin Pract Epidemiol Ment Health. 2007;3:22. doi:10.1186/1745-0179-3-22
  26. Franco FGM, Laurinavicius AG, Lotufo PA, et al. Persistent depressive symptoms are independent predictors of low-grade inflammation onset among healthy individuals. Arq Bras Cardiol. 2017;29:0. doi:10.5935/abc.20170080
  27. Bladowska J, Zimny A, Knysz B, et al. Evaluation of early cerebral metabolic, perfusion and microstructural changes in HCV-positive patients: A pilot study. J Hepatol. 2013;59(4):651–657. doi:10.1016/j.jhep.2013.05.008
  28. Mathew S, Faheem M, Ibrahim SM, et al. Hepatitis C virus and neurological damage. World J Hepatol. 2016;8(12):545–556. doi:10.4254/wjh.v8.i12.545
  29. Forton DM, Karayiannis P, Mahmud N, Taylor-Robinson SD, Thomas HC. Identification of unique hepatitis C virus quasispecies in the central nervous system and comparative analysis of internal translational efficiency of brain, liver, and serum variants. J Virol. 2004;78(10):5170–5183.
  30. Laskus T, Radkowski M, Adair DM, Wilkinson J, Scheck AC, Rakela J. Emerging evidence of hepatitis C virus neuroinvasion. AIDS. 2005;19(Suppl 3):140–144.
  31. Monaco S, Mariotto S, Ferrari S, et al. Hepatitis C virus-associated neurocognitive and neuropsychiatric disorders: Advances in 2015. World J Gastroenterol. 2015;21(42):11974–11983. doi:10.3748/wjg.v21.i42.1197