Published: March 2012
Publications
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).
References
- 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
- Goeb JL, Even C, Nicolas G, et al. 2006. Psychiatric side effects of interferon-beta in multiple sclerosis. European Psychiatry, 21(3): 186-193
- 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.