title: Psychomotor retardation and vulnerability to interferon alpha induced major depressive disorder: Prospective study of a chronic hepatitis C cohort.
abstract: BACKGROUND
  Major depressive disorder (MDD) is a common consequence of interferon alpha (IFNα) treatment and important supporting evidence of a role of inflammation in the aetiology of depression.
  
  
  OBJECTIVE
  This study aimed to expand the knowledge of baseline clinical vulnerability characteristics to IFNα induced MDD, particularly exploring sub-threshold depressive symptoms.
  
  
  METHODS
  A prospective cohort of chronic HCV patients undergoing treatment with pegylated-IFNα and ribavirin was studied. MDD was assessed using the Structured Clinical Interview for DSM-IV (SCID-I). Depressive symptoms and severity were assessed at baseline and monthly with the Hamilton Depression Rating Scale (HAMD). Subjects with MDD or taking antidepressant treatment at baseline were excluded.
  
  
  RESULTS
  278 patients were assessed for this cohort with a final study sample of 190. 94.2% had contracted HCV through intravenous drug use. During six months IFNα treatment, 53.2% of patients transitioned to DSM-IV threshold MDD. In the multivariate logistic analysis, independent factors significantly associated with development of MDD were younger age (OR 0.96, 95% CI 0.93-1.00, p=0.028), past history of MDD (OR 3.82, 95% CI 1.63-8.92, p=0.002), baseline HAMD items psychomotor retardation (OR 15.21, 95% CI 1.33-173.41, p=0.032) and somatic symptoms (general) (OR 2.96, 95% CI 1.44-6.08, p=0.003), and HCV genotype 2 (OR 2.27, 95% CI 1.07-4.78, p=0.032).
  
  
  CONCLUSIONS
  During IFNα treatment, the rate of transition to MDD was high in this cohort. Psychomotor retardation and somatic symptoms may represent a greater inflamed state pre-treatment. This iatrogenic model of MDD may offer important insights into wider depression aetiology.
authors.affiliation: Brighton and Sussex Medical School, United Kingdom; Sussex Partnership NHS Foundation Trust, United Kingdom. Electronic address: richard.whale@brighton.ac.uk.
authors.forename: Richard
authors.initials: R
authors.lastname: Whale
authors.affiliation: Sussex Partnership NHS Foundation Trust, United Kingdom; School of Psychology, University of Sussex, United Kingdom. Electronic address: r.fialho@sussex.ac.uk.
authors.forename: Renata
authors.initials: R
authors.lastname: Fialho
authors.affiliation: Sussex Partnership NHS Foundation Trust, United Kingdom; School of Psychology, University of Sussex, United Kingdom. Electronic address: michael.rolt@nhs.net.
authors.forename: Michael
authors.initials: M
authors.lastname: Rolt
authors.affiliation: Brighton and Sussex Medical School, United Kingdom; Sussex Partnership NHS Foundation Trust, United Kingdom. Electronic address: j.eccles@bsms.ac.uk.
authors.forename: Jessica
authors.initials: J
authors.lastname: Eccles
authors.affiliation: Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal. Electronic address: marcopereira@fpce.uc.pt.
authors.forename: Marco
authors.initials: M
authors.lastname: Pereira
authors.affiliation: Digestive Diseases Centre, Brighton and Sussex University Hospitals NHS Trust, United Kingdom. Electronic address: m.keller@bsuh.nhs.uk.
authors.forename: Majella
authors.initials: M
authors.lastname: Keller
authors.affiliation: Digestive Diseases Centre, Brighton and Sussex University Hospitals NHS Trust, United Kingdom. Electronic address: a.file@bsuh.ac.uk.
authors.forename: Alexandra
authors.initials: A
authors.lastname: File
authors.affiliation: Digestive Diseases Centre, Brighton and Sussex University Hospitals NHS Trust, United Kingdom. Electronic address: i.haq@bsms.ac.uk.
authors.forename: Inam
authors.initials: I
authors.lastname: Haq
authors.affiliation: Digestive Diseases Centre, Brighton and Sussex University Hospitals NHS Trust, United Kingdom. Electronic address: jeremy.tibble@bsuh.nhs.uk.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Tibble
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects*; D003863:Depression / Q000139:chemically induced / Q000503:physiopathology*; D003865:Major Depressive Disorder / Q000139:chemically induced / Q000503:physiopathology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D016898:Interferon-alpha / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011597:Psychomotor Performance / Q000187:drug effects*; D012254:Ribavirin / Q000008:administration & dosage
chemical_list: D000928:Antidepressive Agents; D000998:Antiviral Agents; D016898:Interferon-alpha; D012254:Ribavirin
keywords: Depressive disorder; Hepatitis C; Inflammation; Interferon-alpha; Prospective studies