Interferon-alpha (IFN-α) therapy for chronic hepatitis C virus (HCV) infection is associated with the development of depression and other neuropsychiatric adverse effects. However, well-defined predictors of this depression are still lacking. Several interlinked biological systems as well as cognitive and psychosocial factors may predispose individuals to the development of IFN-α-induced depression. The aim of this study was to identify such predictive factors as well as prospectively monitor the impact of IFN-α on a variety of clinical and biological outcomes. Forty-eight patients with chronic HCV infection were recruited and assessed at baseline and after 4, 8, 12, 16, 20 and 24 weeks of IFN-α treatment. At each assessment, patients were evaluated with a number of questionnaires as well as the structured Mini International Neuropsychiatric Interview (MINI) for a diagnosis of major depressive disorder. Blood samples were also collected at all time points as well as salivary cortisol at baseline and end of treatment. IFN-α-induced depression developed in 40% of patients. Patients who developed IFN-α-induced depression had more negative illness perceptions, lower baseline levels of cortisol during the day, and lower baseline levels of kynurenic acid. Patients who developed IFN-α-induced depression also had altered gene expression in a number of pathways relevant for depression such as inflammation and neuroplasticity. Finally, detection and management of depression in this population is shown to be a complex process, reliant on the availability of clinical experts and good communication within a multidisciplinary team. In conclusion, the findings of this study provide evidence for a number of cognitive, psychosocial and biological predictors of IFN-α-induced depression. These findings provide a rationale to test the effect of preventative cognitive interventions in these patients. However, future studies are needed to confirm some of these novel clinical and biological predictors, as well as to look at the interplay between these factors.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:628220 |
| Date | January 2013 |
| Creators | Hepgul, Nilay |
| Publisher | King's College London (University of London) |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | https://kclpure.kcl.ac.uk/portal/en/theses/cognitive-biological-and-psychosocial-factors-predicting-interferonalphainduced-depression(bcba081e-60d5-4ccb-9085-1b47bb256013).html |
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