[Reflections on the treatment of EDM in hepatitis C virus patients treated with interferon alpha from a retrospective survey concerning 29 patients].
At this moment of new therapeutic protocols and the possibility of curing HCV infections, it is of utmost importance to widen antiviral treatment in many indications, to upgrade compliance, and to limit therapeutic discontinuations. Depressive disorders are probably the main reason for failure of this treatment. The lack of knowledge about depressive disorders and the little specialized psychiatric accompaniment in this field are obviously not beneficial for the patient and his disease (no access to interferon alpha therapy, poor compliance, frequent discontinuations of treatment.);


OBJECTIVE
24 patients (15 men and 9 women) treated by interferon alpha and having a major depressive episode (MDE) (according to the DSM IV) and who were about to discontinue their treatment, had a emergency consultation with the psychiatrist of the network who took them immediately in charge in the most adapted way (psychotropic therapy, psychotherapy, hospitalization.) as well as a long term specialized follow up (up to several months after the treatment was discontinued). From this follow up and based on a retrospective questionnaire proposed to the patients, we have thought about the existence and the relevance of the risk factors of the appearance of MDE under interferon alpha (personal antecedents of depression, of suicide attempts, of antiviral treatment discontinuations, of the drug addiction-induced contamination.) and about the major interest of a psychiatric accompaniment within an organized network.


RESULTS
Among the 29 patients regularly followed during and after the antiviral therapy, 23 (79.3%) received a psychotropic treatment adapted to the clinical situation (82.6% of initially prescribed antidepressants have not been modified) associated the the psychotherapy, 4 (13.7%) were hospitalized in the psychiatric ward where the network psychiatrist works, one attempted to commit suicide without associated depression disorders (hospitalization, no discontinuation of antiviral therapy). More than 90% of patients were able to complete treatment. However, 7 patients (24,1%) had a MDE within the 3 months following treatments (5 patients consulted after their treatment discontinuations even though this treatment was well tolerated and efficient). The frequency of MDE under interferon alpha in patients with personal antecedents of MDE (10 patients, 41.7%) was not significantly different from that found in patients without antecedents of MDE (14 patients, 58.3%). The frequency of MDE under interferon alpha in patients assuming that they had been obviously contaminated by a risky use of drugs (13 patients, 54%) is not significantly different from that found in patients assuming that they had been obviously contaminated by another risky situation (11 patients, 46%). We can wonder, despite of the poor recruitment, about the potential involvement of driving under the influence of alcohol, antecedents of MDE induced-discontinuation of a last treatment by interferon alpha or antecedents of suicide attempt, in the appearance of MDE under interferon alpha. The results are similar in women and men although almost twice as many men had an emergency consultation; 78.5% (11 patients) of already interferon alpha-treated patients in the past (14 patients) considered that the psychiatric accompaniment was extremely beneficial for their psycho-social well-being.


CONCLUSIONS
The antecedents of MDE and drug addiction are not predictive of the appearance of MDE under interferon alpha and should not be considered as a contra-indication of this treatment. A psychiatric accompaniment within a multidisciplinary network provides a major benefit to the patients in terms of compliance and safe care. It is essential to follow up the patients in the months following the end of antiviral treatment, above all if this latter was well-tolerated.
Lang
J-Ph
JP
Service de Psychiatrie du Docteur Legal, M. Epsan, 67720 Hoerdt.
Halleguen
O
O
Vecchionacci
V
V
Doffoel
M
M
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006526:Hepatitis C / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use*; D008297:Male; D011613:Psychotherapy / Q000379:methods; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012189:Retrospective Studies; D013406:Suicide, Attempted / Q000517:prevention & control / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
D000998:Antiviral Agents; D016898:Interferon-alpha; D011619:Psychotropic Drugs