Is the interferon-alpha-triggered depressive episode a self-limited kind of depression? Four cases of persistent affective symptoms after antiviral treatment in HCV-infected individuals

Abstract

Objectives. To discuss relevant aspects in a series of cases in which interferon-alpha-triggered depressive symptoms persisted up to 4 years after therapy cessation in HCV-infected patients. Methods. Two experienced psychiatrists (AGA and LCQ) identified these four cases in a systematic evaluation program of HCV patients in the Hepatology Unit of the Teaching Hospital at the Federal University of Bahia, Brazil. Lifetime psychiatric diagnoses were confirmed by the Mini International Neuropsychiatric Interview (MINI Plus), and a questionnaire was submitted in order to gather clinical and sociodemographic characteristics. Results. in three out of the four cases identified, major depression diagnosis was reached after more than 12 months of interferon-alpha therapy interruption and, in one case, depression recurred 6 months after antiviral treatment cessation in a patient on antidepressants. the only case that referred a past history of psychiatric diagnosis reported no offer of mental health care despite the presence of a major depressive episode with psychotic features and suicidal behaviour during the cytokine usage. Conclusions. Interferon-alpha-triggered depression may remain undiagnosed even in tertiary university hospitals, may persist years after the antiviral therapy cessation, and may recur even in patients on adequate antidepressant treatment.