Hep.org.au

Hepatitis C factsheets
Treatment side effects: mental
Introduction
Impairment of cognition (thought,
perception & reasoning ability) Impairment of cognition
Even after a single low dose of interferon, people Mood disorders/depression
have reported subjectively reduced alertness and slowed performance on a reaction time test up to Assessment
People at risk
Toxicity develops after several weeks of ongoing interferon therapy and includes subjective Treating side effects
complaints of memory loss, depression, lack of initiative, and generalised slowing of thought Pharmacological interventions
Most studies report the resolution of symptoms within 2-3 weeks following therapy. However, some people develop side effects that persist after treatment discontinuation, without any intervening change in their disease status.
Mood disorders/depression
Introduction
The distinction between levels of depression is based on the intensity and duration of depressive Combination therapy involves weekly pegylated symptoms; the presence or absence of associated interferon injections and daily ribavirin capsules. physical, emotional, and cognitive symptoms; and In addition to numerous physiological side effects (flu-like symptoms, joint pain, skin rashes, etc.) The actual rate of interferon-induced depression combination treatment can involve depression, is unknown. When cancer patients treated with impaired concentration, amnesia, confusion, interferon complain of depression, they typically anxiety, sexual dysfunction (such as lack of sex drive mean apathy, fatigue, and slowing of mental or response to sexual stimulus), mild dementia with capabilities. Some people will experience dysphoria apathy and decreased motivation, and cognitive (feeling ill at ease and restless) at the beginning of dysfunction such as memory loss, apathy, and a treatment, with onset of other symptoms. For others, dysphoria comes later, possibly because cognitive symptoms become more severe or difficult to tolerate. Generally speaking, treatment side effects are rarely severe and appear to be dose related and reversible. These people also may experience other On rare occasions, acute (short term) mental status changes, including delirium, psychosis, and depression, including anhedonia (lack of pleasure neurologic (nervous system) syndromes will occur. with previously pleasurable acts) and helplessness. In vulnerable people, symptoms may become more The significance of these side effects increases, difficult over time or with dose escalations, leading however, when they are chronic (long term) and to dose modifications or temporary discontinuation.
markedly impact quality of life in people who are otherwise relatively well.
This factsheet was produced by Hepatitis NSW and was last reviewed in December 2010 Hepatitis Helpline infoline and HepConnect peer support service: 02 9332 1599 / 1800 803 990 Web info: www.hep.org.au Web peer support: www.hepcaustralasia.org Hepatitis NSW Inc is a community-based, non-government organisation, funded by the NSW Health Dept.
There are multiple possible mechanisms by For others, these interventions, which often are which interferon may cause neuropsychiatric (a viewed as concessions, do not help and only add to psychological approach dealing with the nervous system) side effects; unfortunately, little of which is well understood. Fatigue and depression encourage sedentary behaviour (low physical activity) that can be self-reinforcing, and people who are not active should be encouraged to Assessment
maintain some level of physical activity.
All people treated with combination treatment In the event of suicidal ideations (thinking about should be considered at some risk for development suicide), delusions, or panic, therapy should of an affective syndrome (mood swings), and for be discontinued, and the use of anti-psychotic cognitive side effects as well. Although there is no medications may be useful. Whether it is prudent to standard method for assessing treatment induced resume therapy in these cases is a matter of clinical depression, pre-treatment assessment should be judgment, although it is probably advisable to done so that changes can be reliably detected and reduce the dose of interferon and closely monitor People at risk
Pharmacological interventions
Evidence of current or past depression should not Medications to address interferon-induced be automatic grounds for exclusion from therapy, depression have not been formally studied in but does suggest that the person would be at higher controlled clinical trials; however, a number of risk for side effects. People currently treated with medications are currently used, and the lessening of antidepressants should be monitored for needed psychological side effects appears to be a realistic dose adjustments or medication changes.
goal. At least three classifications of drugs have shown some use.
Treating side effects
Antidepressants
Attempts to lessen or prevent treatment-induced psychological side effects have been hindered by Although single case reports have documented a number of factors, including lack of recognition successful use of fluoxetine and nortriptyline in of the problem, a poor understanding of how people treated with interferon for hep C, there psychological side effects are caused, and a lack have been no published studies of the value of of scientific trials of pharmacological interventions antidepressants commonly prescribed for interferon- (additional medicines to prevent side effects).
To intervene effectively it is first necessary to raise In the cancer treatment setting, SSRIs (selective a person’s awareness of the possible problems. seratonin receptor inhibitors) have been used with Discussion of possible side effects should take place some success. These medicines may counteract before treatment. interferon-induced decreases in serum serotonin levels. Antidepressants, such as fluoxetine, may be People undergoing combination treatment are advantageous because they also may improve the sometimes reluctant to complain of depression or cognitive and behavioural slowing associated with impaired cognitive function. This may be due to the stigma associated with psychiatric illness, or because they fear that they will be given a lower Tricyclic antidepressants are relatively more sedating than SSRIs. These medications increase levels of norepinephrine and, for many, serotonin. Some people who complain of mood or cognitive side The anti-muscarinic effects of some tricyclic effects can be instructed to either pace themselves antidepressants can aggravate memory dysfunction or alter their demanding work and recreational secondary to interferon therapy itself.
schedules to help maintain some reasonable amount of participation in normal activities. This factsheet was produced by Hepatitis NSW and was last reviewed in December 2010 Hepatitis Helpline infoline and HepConnect peer support service: 02 9332 1599 / 1800 803 990 Web info: www.hep.org.au Web peer support: www.hepcaustralasia.org Hepatitis NSW Inc is a community-based, non-government organisation, funded by the NSW Health Dept.
Hepatitis C factsheets
Treatment side effects: mental
Opioid antagonists
To date, the only study to evaluate opioid antagonists (a drug that opposes the effect of another) in this setting has investigated the opioid antagonist Naltrexone. The majority of people in this pilot study experienced partial or complete resolution of psychological symptoms; however, a consistent domain of psycholgical improvement could not be identified.
Psychostimulants
The use of psychostimulants to treat secondary depression is increasing. Methylphenidate is currently being investigated to treat interferon neurotoxicity. Their mood-elevating effects could be caused by their neurochemical activity or by a beneficial psychological reaction due to increased energy and improved concentration.
Also see
Treatment consent (factsheet)
Treatment overview (factsheet)
Treatment response (factsheet)
Treat It, Beat It (booklet)
Treat yourself right (booklet)
What you need to know: a guide to hepatitis C
(booklet)
For more information, contact the Hepatitis Helpline on 9332 1599 (Sydney callers) or 1800 803 990 (NSW regional callers).
• This factsheet was developed by Hepatitis NSW. It was abridged from “Mood & Cognitive Side Effects of Interferon-alpha Therapy”, Seminars in Oncology, Vol 25, No 1, Supplement I (February), 1998, pp 39-47 by A. D. Valentine, et al. It has been reviewed by the Hepatitis NSW Medical & Research Advisory Panel.
This factsheet was produced by Hepatitis NSW and was last reviewed in December 2010 Hepatitis Helpline infoline and HepConnect peer support service: 02 9332 1599 / 1800 803 990 Web info: www.hep.org.au Web peer support: www.hepcaustralasia.org Hepatitis NSW Inc is a community-based, non-government organisation, funded by the NSW Health Dept.
This factsheet was produced by Hepatitis NSW and was last reviewed in December 2010 Hepatitis Helpline infoline and HepConnect peer support service: 02 9332 1599 / 1800 803 990 Web info: www.hep.org.au Web peer support: www.hepcaustralasia.org Hepatitis NSW Inc is a community-based, non-government organisation, funded by the NSW Health Dept.

Source: http://www.hep.org.au/documents/factsheets/TreatmentSideEffectsMental2010.pdf