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An Easy Preventive Treatment of Depression Induced by Interferon

Summary and Comment |
February 13, 2014

An Easy Preventive Treatment of Depression Induced by Interferon

  1. Steven Dubovsky, MD

Prophylaxis with omega-3s decreases the risk.

  1. Steven Dubovsky, MD

Pretreatment with antidepressants can prevent depression caused by interferon-α (IFN) treatment of hepatitis C and other disorders, but antidepressants can be complicated to use in this setting. To find an alternative prophylaxis, researchers examined the effect of omega-3 polyunsaturated fatty acids for just 2 weeks prior to 6 months of treatment with IFN and ribavirin. A total of 162 hepatitis C patients were randomized to eicosapentaenoic acid (EPA; 3.50 g), docosahexaenoic acid (DHA; 1.75 g), or placebo; 152 completed IFN treatment and were included in the analysis.

Over the course of IFN treatment, the incidence of depression was significantly lower with EPA pretreatment (10%) than with placebo (30%; DHA pretreatment, 28%). When IFN-induced depression did occur, onset was significantly delayed with EPA or DHA pretreatment (12 weeks vs. 5 weeks with placebo). DHA pretreatment increased DHA levels, whereas EPA pretreatment increased both EPA and DHA levels.

Comment

Interferon-α increases activity of pro-inflammatory cytokines such as tumor necrosis factor-α, levels of which are correlated with the risk for IFN-induced depression. Anti-inflammatory effects of EPA, which is metabolized to DHA, may prevent this process. In view of how well omega-3s are tolerated, brief pretreatment with EPA before starting a course of IFN seems indicated as an initial strategy, and antidepressants can be started during treatment if depression does occur.

Note to Readers: At the time that NEJM JW reviewed this paper, its publisher noted that it was not in final form and that subsequent corrections might be made.

  • Disclosures for Steven Dubovsky, MD at time of publication Grant / research support Amgen; Janssen; Otsuka; Sunovion; Takeda Editorial boards Bulletin of the Menninger Clinic; Current Psychiatry; Journal of Psychosomatic Research

Citation(s):

Reader Comments (1)

Bruce Kenney, DO Physician, Central Maine Medical Center FM Residency, Lewiston, Maine

What is the opinion of the authors or others whether to continue the EPA dosing during the course of interferon treatment? Does it interfere with the therapeutic effect of the interferon?

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