title: Severe depression, suicide attempts, and ideation during the use of interferon beta by patients with multiple sclerosis.
abstract: BACKGROUND
  Interferon (IFN) beta is a safe and efficient drug for treating multiple sclerosis (MS). It is widely accepted that previously depressed patients may get worse when using IFN-beta. There are few reports on the association of IFN-beta and severe depression among patients without previous psychiatric history.
  
  
  METHODS
  Discussion of a case of a patient with MS who developed severe depression and attempted suicide while using IFN-beta encouraged us to review the subject. A group of neurologists in Brazil retrospectively gathered together their similar cases for the present paper.
  
  
  RESULTS
  The present paper reports on 11 cases of severe depression with suicide attempts or ideation among patients with MS who were using IFN-beta. These patients had no previous history of any psychiatric disease. Nine patients developed the symptoms over a relatively short period (4 months, on average). Two patients developed severe depression after more than 1 year of treatment with IFN-beta. Phobic, aggressive, behavioral, psychotic, and manic symptoms also were observed in these patients, thus suggesting the existence of a complex mood-behavior disorder associated with this drug. Interferon beta withdrawal led to complete remission of symptoms. The Naranjo algorithm established a highly probable association between IFN-beta and this adverse reaction in these patients.
  
  
  CONCLUSIONS
  Although uncommon, severe depression with suicide ideation or attempts may be observed during treatment of MS with IFN-beta. This association should not discourage the use of this drug, but physicians need to be aware of this possible adverse event from IFN-beta.
authors.affiliation: Universidade Metropolitana de Santos, São Paulo, Brazil. yara@bsnet.com.br
authors.forename: Yara Dadalti
authors.initials: YD
authors.lastname: Fragoso
authors.forename: Elizabeth Regina Comini
authors.initials: ER
authors.lastname: Frota
authors.forename: Juarez Silva
authors.initials: JS
authors.lastname: Lopes
authors.forename: Janaina Silveira
authors.initials: JS
authors.lastname: Noal
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Giacomo
authors.forename: Sidney
authors.initials: S
authors.lastname: Gomes
authors.forename: Marcus Vinicius Magno
authors.initials: MV
authors.lastname: Gonçalves
authors.forename: Paulo Diniz
authors.initials: PD
authors.lastname: da Gama
authors.forename: Alessandro
authors.initials: A
authors.lastname: Finkelsztejn
mesh_terms: D000328:Adult; D001938:Brazil / Q000453:epidemiology; D003866:Depressive Disorder / Q000139:chemically induced* / Q000150:complications / Q000453:epidemiology; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D007370:Interferon Type I / Q000009:adverse effects* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000139:chemically induced / Q000150:complications / Q000453:epidemiology; D009103:Multiple Sclerosis / Q000150:complications / Q000188:drug therapy* / Q000523:psychology*; D015995:Prevalence; D011994:Recombinant Proteins; D059020:Suicidal Ideation; D013406:Suicide, Attempted; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007370:Interferon Type I; D011994:Recombinant Proteins