An Easy Preventive Treatment of Depression Induced by Interferon

An Easy Preventive Treatment of Depression Induced by Interferon 

Steven Dubovsky, MD reviewing Su K-P et al. Biol
Psychiatry 2014 Jan 27.

Prophylaxis with omega-3s decreases the risk.

Source

Pretreatment with antidepressants can prevent depression caused by interferon-α (IFN) treatment of hepatitis C and other disorders, but antidepressants can be complicated to use in this setting. To find an alternative prophylaxis, researchers examined the effect of omega-3 polyunsaturated fatty acids for just 2 weeks prior to 6 months of treatment with IFN and ribavirin. A total of 162 hepatitis C patients were randomized to eicosapentaenoic acid (EPA; 3.50 g), docosahexaenoic acid (DHA; 1.75 g), or placebo; 152 completed IFN treatment and were included in the analysis.

Over the course of IFN treatment, the incidence of depression was significantly lower with EPA pretreatment (10%) than with placebo (30%; DHA pretreatment, 28%). When IFN-induced depression did occur, onset was significantly delayed with EPA or DHA pretreatment (12 weeks vs. 5 weeks with placebo). DHA pretreatment increased DHA levels, whereas EPA pretreatment increased both EPA and DHA levels.

Comment 
 Interferon-α increases activity of pro-inflammatory cytokines such as tumor necrosis factor-α, levels of which are correlated with the risk for IFN-induced depression. Anti-inflammatory effects of EPA, which is metabolized to DHA, may prevent this process. In view of how well omega-3s are tolerated, brief pretreatment with EPA before starting a course of IFN seems indicated as an initial strategy, and antidepressants can be started during treatment if depression does occur. Note to Readers: At the time that NEJM JW reviewed this paper, its publisher noted that it was not in final form and that subsequent corrections might be made. 

Editor Disclosures at Time of Publication Disclosures for Steven Dubovsky, MD at time of publication Grant / research support Amgen; Janssen; Otsuka; Sunovion; Takeda Editorial boards Bulletin of the Menninger Clinic; Current Psychiatry; Journal of Psychosomatic Research

Citation(s): Su K-P et al. Omega-3 fatty acids in the prevention of interferon-alpha-induced depression: Results from a randomized, controlled trial. Biol Psychiatry 2014 Jan 27; [e-pub ahead of print]. ((http://dx.doi.org/10.1016/j.biopsych.2014.01.008