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Risk factors for the development of depression in patients with hepatitis C taking interferon-α.

Smith KJ, Norris S, O'Farrelly C, O'Mara SM - Neuropsychiatr Dis Treat (2011)

Bottom Line: Interferon-α, currently used for the treatment of hepatitis C, is associated with a substantially elevated risk of depression.The identification of risk factors prior to treatment may allow identification of patients who will become depressed on interferon, allowing the possibility of improved treatment support and rates of treatment adherence.Here, we consolidate and review the literature on risk factors, and we discuss the potential confounds within the research examined in order to better isolate the risk factors that may be important in the development of depression in these patients and which might help predict patients likely to become depressed on treatment.

View Article: PubMed Central - PubMed

Affiliation: Trinity College Institute of Neuroscience.

ABSTRACT
Interferon-α, currently used for the treatment of hepatitis C, is associated with a substantially elevated risk of depression. However, not everyone who takes this drug becomes depressed, so it is important to understand what particular factors may make some individuals more 'at risk' of developing depression than others. Currently there is no consensus as to why interferon-induced depression occurs and the range of putative risk factors is wide and diverse. The identification of risk factors prior to treatment may allow identification of patients who will become depressed on interferon, allowing the possibility of improved treatment support and rates of treatment adherence. Here, we consolidate and review the literature on risk factors, and we discuss the potential confounds within the research examined in order to better isolate the risk factors that may be important in the development of depression in these patients and which might help predict patients likely to become depressed on treatment. We suggest that interactions between psychobehavioral, genetic, and biological risk factors are of particular importance in the occurrence of depression in patients with hepatitis C taking interferon-α.

No MeSH data available.


Related in: MedlinePlus

Tyrptophan–Kynurenine pathway. Diagram showing the alteration of tryptophan metabolism by IFN-α. Tryptophan is normally converted in 5-hydroxy tryptophan (5-HTP) and serotonin (5-HT). However, this metabolism is switched to the KYN pathway by IDO, which is induced by immune stimuli such as IFN-α, and it is this pathway that produced the neurotoxin quinolinic acid (QUIN). Copyright © 2002, Elsevier. Adapted with permission from Konsman JP, Parnet P, Dantzer R. Cytokine-induced sickness behaviour: mechanisms and implications. Trends Neurosci. 2002;25(3):154–159.
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f1-ndt-7-275: Tyrptophan–Kynurenine pathway. Diagram showing the alteration of tryptophan metabolism by IFN-α. Tryptophan is normally converted in 5-hydroxy tryptophan (5-HTP) and serotonin (5-HT). However, this metabolism is switched to the KYN pathway by IDO, which is induced by immune stimuli such as IFN-α, and it is this pathway that produced the neurotoxin quinolinic acid (QUIN). Copyright © 2002, Elsevier. Adapted with permission from Konsman JP, Parnet P, Dantzer R. Cytokine-induced sickness behaviour: mechanisms and implications. Trends Neurosci. 2002;25(3):154–159.

Mentions: The neurotransmitter serotonin has long been believed to play a role in depression;48,49 however, more recent research has linked the observed decrease in serotonin with a cytokine-mediated pathway.50,51 When IFN-α is administered, it has been shown that there is an upregulation of the enzyme indoleamine 2,3-dioxygenase (IDO) that metabolizes tryptophan, the precursor to serotonin.34 Thus, when IDO is overstimulated, there is potentially a reduction in plasma tryptophan and serotonin in the brain (see Figure 1),42,45,52 which may lead to depression.51


Risk factors for the development of depression in patients with hepatitis C taking interferon-α.

Smith KJ, Norris S, O'Farrelly C, O'Mara SM - Neuropsychiatr Dis Treat (2011)

Tyrptophan–Kynurenine pathway. Diagram showing the alteration of tryptophan metabolism by IFN-α. Tryptophan is normally converted in 5-hydroxy tryptophan (5-HTP) and serotonin (5-HT). However, this metabolism is switched to the KYN pathway by IDO, which is induced by immune stimuli such as IFN-α, and it is this pathway that produced the neurotoxin quinolinic acid (QUIN). Copyright © 2002, Elsevier. Adapted with permission from Konsman JP, Parnet P, Dantzer R. Cytokine-induced sickness behaviour: mechanisms and implications. Trends Neurosci. 2002;25(3):154–159.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3101888&req=5

f1-ndt-7-275: Tyrptophan–Kynurenine pathway. Diagram showing the alteration of tryptophan metabolism by IFN-α. Tryptophan is normally converted in 5-hydroxy tryptophan (5-HTP) and serotonin (5-HT). However, this metabolism is switched to the KYN pathway by IDO, which is induced by immune stimuli such as IFN-α, and it is this pathway that produced the neurotoxin quinolinic acid (QUIN). Copyright © 2002, Elsevier. Adapted with permission from Konsman JP, Parnet P, Dantzer R. Cytokine-induced sickness behaviour: mechanisms and implications. Trends Neurosci. 2002;25(3):154–159.
Mentions: The neurotransmitter serotonin has long been believed to play a role in depression;48,49 however, more recent research has linked the observed decrease in serotonin with a cytokine-mediated pathway.50,51 When IFN-α is administered, it has been shown that there is an upregulation of the enzyme indoleamine 2,3-dioxygenase (IDO) that metabolizes tryptophan, the precursor to serotonin.34 Thus, when IDO is overstimulated, there is potentially a reduction in plasma tryptophan and serotonin in the brain (see Figure 1),42,45,52 which may lead to depression.51

Bottom Line: Interferon-α, currently used for the treatment of hepatitis C, is associated with a substantially elevated risk of depression.The identification of risk factors prior to treatment may allow identification of patients who will become depressed on interferon, allowing the possibility of improved treatment support and rates of treatment adherence.Here, we consolidate and review the literature on risk factors, and we discuss the potential confounds within the research examined in order to better isolate the risk factors that may be important in the development of depression in these patients and which might help predict patients likely to become depressed on treatment.

View Article: PubMed Central - PubMed

Affiliation: Trinity College Institute of Neuroscience.

ABSTRACT
Interferon-α, currently used for the treatment of hepatitis C, is associated with a substantially elevated risk of depression. However, not everyone who takes this drug becomes depressed, so it is important to understand what particular factors may make some individuals more 'at risk' of developing depression than others. Currently there is no consensus as to why interferon-induced depression occurs and the range of putative risk factors is wide and diverse. The identification of risk factors prior to treatment may allow identification of patients who will become depressed on interferon, allowing the possibility of improved treatment support and rates of treatment adherence. Here, we consolidate and review the literature on risk factors, and we discuss the potential confounds within the research examined in order to better isolate the risk factors that may be important in the development of depression in these patients and which might help predict patients likely to become depressed on treatment. We suggest that interactions between psychobehavioral, genetic, and biological risk factors are of particular importance in the occurrence of depression in patients with hepatitis C taking interferon-α.

No MeSH data available.


Related in: MedlinePlus