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Publications

Published: March 2012

Reminder: Depression and Suicidality Can Occur With Interferon Use

Prescriber Update 33(1): 6
March 2012

Prescribers are reminded that depression and/ or suicidal ideation are commonly reported side effects of interferon alpha therapy and have also been reported with interferon beta use1,2.

Prescribers should also be aware that patients with chronic hepatitis C infection and multiple sclerosis (MS) have a high background risk of psychiatric disorders such as depression.

Interferons are naturally occurring cytokines with antiviral and immunomodulatory properties. The three major interferon classes (alpha, beta and gamma) have overlapping but distinct biological activities.

Interferon alpha is indicated for the treatment of chronic hepatitis B and C infection, haematological malignancies (e.g. hairy cell leukaemia, chronic myelogenous leukemia, multiple myeloma and non-Hodgkin’s lymphoma) and Kaposi’s sarcoma. Interferon beta is indicated for the treatment of MS.

The Centre for Adverse Reaction Monitoring (CARM) has received six reports of suicidal ideation/tendency and three reports of death by suicide, associated with the use of interferon alpha. This includes three patients taking pegylated interferon plus ribavirin.

Indications for use were hepatitis C (5), chronic myelogenous leukemia (1) and unknown (3). The duration to onset of symptoms ranged from two weeks to 11 months (average 4.8 months). Of the nine patients, five patients had other risk factors for suicidal ideation including hepatitis C infection (5), intravenous drug use (1) concomitant ribavirin (2) and co-existing depression (4).

Possible activation symptoms (e.g. agitation, anxiety, aggression and irritability) were also experienced by six patients. The extent of additional psychosocial factors was not reported.

CARM has also received one report of suicidal ideation with interferon beta (in a patient with MS).

Key Advice for Healthcare Professionals1,3

  • Patients should be screened for psychiatric symptoms prior to interferon treatment.
  • Interferon should be used with caution and psychiatric review should be considered in patients with current depression or a history of depression.
  • Mood and suicidal ideation should be monitored closely during interferon therapy.
  • Patients should be advised to seek medical advice immediately if symptoms of depression or suicidal ideation occur or worsen during interferon treatment.
  • Specialist advice should be sought if depression and/or suicidal ideation do not improve with treatment. The potential benefit of ongoing interferon treatment should be weighed carefully against the risks of worsening depression.
References
  1. Sockalingam S, Links PS, Abbey SE. 2011. Suicide risk in hepatitis C and during interferon-alpha therapy: a review and clinical update. Journal of Viral Hepatitis, 18(3): 153-160
  2. Goeb JL, Even C, Nicolas G, et al. 2006. Psychiatric side effects of interferon-beta in multiple sclerosis. European Psychiatry, 21(3): 186-193
  3. Roche Products (New Zealand) Limited. 2011. Pegasys data sheet

Note: PHARMAC fully subsidises interferon alpha (Pegasys, Pegasys RBV, Intron A and Roferon A) under special authority for the treatment of chronic hepatitis B and C infection and interferon beta (Avonex and Betaferon) for the treatment of MS.

 

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