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Abstract
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OBJECTIVE: A bibliographical review on hepatitis C, evaluating the diagnostic criteria for depression in each of the articles.
METHOD: A search of the Silver Platter Medline, 1991-2001, for English, Spanish and French furnished the data from which the articles were selected. The key-words used were depression and interferon. Each article was read to find how many patients were studied, which diagnostic methodology and scales of symptom intensity were used, and the name of the professional responsible for the psychiatric evaluation.
RESULTS: Initial data from the eighties describe depressive symptons as part of the case histories of patients using interferon. After that, cases of suicide within this patient group were seen. This led to more systematic research to identify factors which might predict which patients could eventually develop depression or suicidal ideation. Consequently, patients with prior psychiatric histories were removed from the study. This considers a therapeutic response to interferon as barely 20% (defining an undetectable viral response as maintenance of fewer than 100 copies/ml of virus C, RNA). When ribavirin, an analog nucleoside, was added to the treatment, the rate of positive results from the treatment increased by approximately 50%; this improvement in the long-term response justified its use as a viable treatment option for these patients. More recent articles report that it is now possible to monitor these patients and include them in treatment protocols using antidepressant medication. To avoid ruling out interferon as a treatment option, patients should be evaluated by a psychiatry before initiating treatment. This allows for follow-up and treatment, when necessary.
CONCLUSION: The incidence of depression in patients treated with interferon varies from 3% to 57%. We can attribute these variations to several factors, including the selection of the population, when drug-users were included in the studies, the disease being studied (the incidence of depression is greater in hepatitis C than in multiple sclerosis, even when untreated). The method of study, differing sensitivities of the instruments used and variations in interviewer training also help to explain the divergent numbers reported. Comparative studies between varying types of interferon show that variations in the incidence of depression among them do exist.
Language: pt |