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

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 Montgomery-A°sberg 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. Conclusions. 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.