Interferon alpha-2b

Reactions 916 - 24 Aug 2002 S Interferon alpha-2b Depression: case report A 51-year-old man developed severe depression during treatment with interferon-α-2b for malignant melanoma. He had a previous history of major depressive disorder, obsessive-compulsive disorder and post-traumatic stress disorder and had attempted suicide 5 years earlier; however, his psychiatric symptoms were stable at the start of interferon- α-2b therapy. Following surgical removal of the malignant melanoma lesion, the man received IV interferon-α-2b 20MU/m 2 5 times weekly for 4 weeks. One week after starting interferon-α-2b, he became depressed with excessive ruminative thoughts, so olanzapine was added to his existing regimen of citalopram. After 4 weeks’ treatment with interferon-α-2b, he had severe depression with suicidal ideation, and he was hospitalised. On examination the man had depression, anxiety, a dysphoric affect, obsessive ruminations and suicidal ideation. Due to the severity of his depression, he underwent 4 unilateral ECT treatments. His olanzapine dosage was then reduced and he was treated with a benzodiazepine when needed for sleep and anxiety. He also had hypothyroidism which was suspected to be caused by interferon-α-2b, but this was not treated. His depression improved after ECT and he was discharged without any signs of severe anxiety or suicidal ideation. Interferon-α-2b was discontinued. The man’s mood remained stable for 15 months after discharge. However, he was then rehospitalised with a severe recurrence of depression and suicidal ideation following 3 months of alcohol abuse. His mood rapidly stabilised after undergoing alcohol detoxification and minor adjustments in his medications. He remained stable during follow-up. Author comment: This patient’s depression ‘could have represented a recurrence of MDD [major depressive disorder] that was completely independent of interferon therapy. However, the temporal relationship between IFN-A [interferon- α-2b] initiation and his development of mood symptoms suggests an interferon-induced recurrence of depression.’ Okereke OI. Neuropsychiatric complications associated with interferon-alpha-2b treatment of malignant melanoma. Psychosomatics 43: 237-240, May-Jun 2002 - USA 807209681 1 Reactions 24 Aug 2002 No. 916 0114-9954/10/0916-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

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Transcript of Interferon alpha-2b

Reactions 916 - 24 Aug 2002

SInterferon alpha-2b

Depression: case reportA 51-year-old man developed severe depression during

treatment with interferon-α-2b for malignant melanoma. Hehad a previous history of major depressive disorder,obsessive-compulsive disorder and post-traumatic stressdisorder and had attempted suicide 5 years earlier; however,his psychiatric symptoms were stable at the start of interferon-α-2b therapy.

Following surgical removal of the malignant melanomalesion, the man received IV interferon-α-2b 20MU/m2 5 timesweekly for 4 weeks. One week after starting interferon-α-2b,he became depressed with excessive ruminative thoughts, soolanzapine was added to his existing regimen of citalopram.After 4 weeks’ treatment with interferon-α-2b, he had severedepression with suicidal ideation, and he was hospitalised.

On examination the man had depression, anxiety, adysphoric affect, obsessive ruminations and suicidal ideation.Due to the severity of his depression, he underwent 4unilateral ECT treatments. His olanzapine dosage was thenreduced and he was treated with a benzodiazepine whenneeded for sleep and anxiety. He also had hypothyroidismwhich was suspected to be caused by interferon-α-2b, but thiswas not treated. His depression improved after ECT and hewas discharged without any signs of severe anxiety or suicidalideation. Interferon-α-2b was discontinued.

The man’s mood remained stable for 15 months afterdischarge. However, he was then rehospitalised with a severerecurrence of depression and suicidal ideation following 3months of alcohol abuse. His mood rapidly stabilised afterundergoing alcohol detoxification and minor adjustments inhis medications. He remained stable during follow-up.

Author comment: This patient’s depression ‘could haverepresented a recurrence of MDD [major depressive disorder]that was completely independent of interferon therapy.However, the temporal relationship between IFN-A [interferon-α-2b] initiation and his development of mood symptomssuggests an interferon-induced recurrence of depression.’Okereke OI. Neuropsychiatric complications associated with interferon-alpha-2btreatment of malignant melanoma. Psychosomatics 43: 237-240, May-Jun 2002 -USA 807209681