Neuropsychiatric side effects associated with interferon-alfa plus ribavirin therapy: Treatment and prevention
- Charles L Raison, MD
Charles L Raison, MD
- Professor, Department of Psychiatry
- School of Medicine and Public Health
- University of Wisconsin-Madison
- Nezam H Afdhal, MD, FRCPI
Nezam H Afdhal, MD, FRCPI
- Senior Physician in Hepatology
- Beth Israel Deaconess Medical Center
Few well designed studies are available to provide definitive guidance on preventing or alleviating the many neuropsychiatric side effects associated with interferon-alfa (IFN-alfa) plus ribavirin. Fortunately, several placebo-controlled studies confirm clinical experience by demonstrating that side effects can be managed effectively in many patients. Nonetheless, the recommendations that follow are based mainly upon observational studies and experience in treatment of psychiatric syndromes in other settings.
The guidelines found on product information sheets (ie, dosage reduction of IFN-alfa as a treatment for depression) are not sufficiently comprehensive to address the clinical issues that arise during treatment. They do not adequately consider the tradeoff between managing depression and the reduction in efficacy of treatment associated with a dose reduction, especially early in the course of therapy. In addition, the effectiveness of dose-reduction in resolving treatment-emergent neuropsychiatric side effects remains to be conclusively determined.
We believe that a better strategy is to use all techniques at our disposal (pharmacological and psychosocial) to allow patients to tolerate full doses of IFN-alfa/ribavirin for an appropriate period while minimizing negative impact on emotional and physical well-being and daily functioning.
This topic review will summarize the treatment and prevention of neuropsychiatric side effects in patients receiving IFN-alfa plus ribavirin for hepatitis C virus infection. Recognition and risk factors are presented separately. (See "Neuropsychiatric side effects associated with interferon plus ribavirin for treatment of hepatitis C: Recognition and risk factors".)
Patients who are candidates for interferon-alfa (IFN-alfa) are often referred to psychiatrists to evaluate the risk of adverse psychiatric outcomes . The role of the psychiatrist includes:
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- PSYCHIATRIC CONSULTATION
- PSYCHOSOCIAL CONTEXT OF TREATMENT
- WHO CAN BE SAFELY TREATED WITH INTERFERON
- WHEN TO TREAT FOR INTERFERON PSYCHIATRIC SIDE EFFECTS
- After onset of depression
- INSOMNIA, PAIN, ANOREXIA AND IRRITABILITY
- Aches and pains
- HOW LONG SHOULD TREATMENT LAST
- SUICIDAL IDEATION
- IFN-alfa in patients with psychiatric illness
- SUMMARY AND RECOMMENDATIONS