• Abdul Shakoor
  • Farzana Shafqat
  • Tafazzul e Haque Mehmud
  • Mohammad Akram
  • Sarah Riaz
  • Zafar Iqbal
  • Anwaar A Khan


Background: Large numbers of patients suffering from Chronic Hepatitis C (HCV) are seekingtreatment with interferon alpha (IFN) because of significant advances in overall improvement inthe course of HCV and its complications. Objectives were to estimate the frequency of depressionand somatic symptoms in patients on interferon alpha/ribavirin treatment for chronic hepatitis C.Methods: It was an observational study conducted in the out-patient Department ofGastroenterology Shaikh Zayed Hospital, Lahore during a period of three months, i.e., fromSeptember to November 2008. One hundred consecutive patients undergoing interferon alpha/ribavirin treatment for chronic HCV were included in the study. All patients, irrespective of age,sex or duration of treatment were administered with a check list of common physical complaintsand DSM-IV symptoms for Major Depressive Episode. Results: Out of a total of 100 subjects 37were male and 63 were female. In all, 39 (39%) patients fulfilled the diagnostic criteria of DSMIV for Major Depressive Episode. Major Depression was more common in female 28 (44.4%) ascompared to male 11 (28.7%) patients. Somatic symptoms were common in all the patients butthey were reported more frequently by patients with Major Depression compared to those withoutMajor Depression. Myalgias, headache, joint pain, nausea/vomiting, abdominal pain andpalpitation were the most common physical symptoms. Conclusion: Major Depression andsomatic complaints are a common consequence of interferon alpha/ribavirin treatment for chronichepatitis C. All patients receiving this treatment should be periodically assessed for the detectionof these side effects to promptly address relevant treatment options.Keywords: Interferon Alpha, Ribavirin, Hepatitis C, Depression


Maddock C, Landau S, Barry K, Maulayah P, Hotopf M,

Cleare AJ, et al. Psychopathological symptoms during

interferon-alpha and ribavirin treatment: effects on virologic

response. Mol Psychiatry 2005;10:332–3.

Wichers MC, Koek GH, Robaeys G, Praamstra AJ, Maes M.

Early increase in vegetative symptoms predicts IFN-alphainduced cognitive-depressive changes. Psychol Med


Guadagnino V, Trotta MP, Carioti J, Caroleo B, Antinori A:

for the Nocchiero Study Group. Does depression

symptomatology affect medication compliance during the

J Ayub Med Coll Abbottabad 2010;22(4) 9

first weeks of anti-HCV therapy in intravenous drug users?

Dig Liver Dis 2006;38:119–24.

McHutchison JG, Ware JE Jr, Bayliss MS, Pianko S,

Albrecht JK, Cort S, et al. The effects of interferon alpha-2b

in combination with ribavirin on health related quality of life

and work productivity. J Hepatol 2001;34:140–7.

Bernstein D, Kleinman L, Barker CM, Revicki DA, Green J.

Relationship of health-related quality of life to treatment

adherence and sustained response in chronic hepatitis C

patients. Hepatology 2002;35:704–8.

Dan AA, Martin LM, Crone C, Ong JP, Farmer DW, Wise T,

et al. Depression, anemia and health-related quality of life in

chronic hepatitis C. J Hepatol 2006;44:491–8.

Lisa AM, Mary FB, Bryan JM, Robert MV, Ravi L, Stanley

DR. Hepatitic C treatment for people with severe mental

illness. Psychomatics 2006;47:93–107

Raison CL, Borisov AS, Broadwell SD, Capuron L,

Woolwine BJ, Jacobson IM, et al. Depression during

pegylated interferon-alpha plus ribavirin therapy: prevalence

and prediction. J Clin Psychiatry 2005;66:41–8.

Manns MP, McHutchison JG, Gordon SC, Rustgi VK,

Shiffman M, Reindollar R, et al. Peginterferon alpha-2b plus

ribavirin compared with interferon alpha-2b plus ribavirin for

initial treatment of chronic hepatitis C: a randomised trial.

Lancet 2001; 358:958–65.

Fried MW, Shiffman ML, Reddy KR, Smith C, Marinos G,

Gonçales FL Jr, et al. Peginterferon alpha-2a plus ribavirin

for chronic hepatitis C virus infection. N Engl J Med


Bagheri H, Fouladi A, Barange K, Lapeyre-Mestre M, Payen

JL, Montastruc JL, et al. Follow-up of adverse drug reactions

from peginterferon alpha-2b-ribavirin therapy.

Pharmacotherapy 2004;24:1546–53.

Bonaccorso S, Marino V, Puzella A, Pasquini M, Biondi M,

Artini M, et al. Increased depressive ratings in patients with

hepatitis C receiving interferon alpha based immunotherapy

are related to interferon-alpha-induced changes in the

serotonergic system. J Clin Psychopharmacol 2002;22:86–90.

American Psychiatric Association. Diagnostic and Statistical

Manual of Mental Disorders, 4th Ed. Washington DC:

American Psychiatric Association; 1994.

Maddrey WC. Update in hepatology. Ann Intern Med


Malik IA, Khan SA, Tariq WUZ. Hepatitis C virus in

perspective; where do we stand. J Coll Physicians Surg Pak


Maddock C, Baita A, Orru MG, Sitzia R, Costa A, Muntoni

E, et al. Psychopharmacological treatment of depression,

anxiety, irritability and insomnia in patients receiving

interferon-alpha: a prospective case series and a discussion of

biological mechanisms. J Psychopharmacol 2004;18:41–6.

Rifai MA, Loftis JM, Hauser P. Interferon-alpha treatment of

patients with Hepatitis C: the role of a comprehensive riskbenefit assessment. CNS Drugs 2005;19:719–22.

Knott A, Dieperink E, Willenbring ML, Heit S, Durfee JM,

Wingert M, et al. Integrated psychiatric/medical care in a chronic

hepatitis C clinic: effect on antiviral treatment evaluation and

outcomes. Am J Gastroenterol 2006;101:2254–62.

Kraus MR, Schafer A, Faller H, Csef H, Scheurlen M..

Paroxetine for the treatment of interferon-alpha-induced

depression in chronic hepatitis C. Aliment Pharmacol Ther


Horikawa N, Yamazaki T, Izumi N, Uchihara M. Incidence

and clinical course of major depression in patients with

chronic hepatitis type C undergoing interferon-alpha therapy:

a prospective study. Gen Hosp Psychiatry 2003;25:34–8.

Kraus MR, Schafer A, Faller H, Csef H, Scheurlen M.

Psychiatric symptoms in patients with chronic hepatitis C

receiving interferon alpha-2b therapy. J Clin Psychiatry





Most read articles by the same author(s)

1 2 > >>