Neuropsychiatric side effects of HCV therapy and their treatment: focus on IFN alpha-induced depression.

Psychiatric disorders, particularly depression, and substance-use disorders (SUDs) are common comorbidities in patients who have chronic hepatitis C virus (HCV) infection. Patients who are infected with HCV who are treated with interferon alfa (IFNalpha) are also at significant risk for IFNalpha-induced depression (incidence, ~20-30%) and other neuropsychiatric side effects that can affect treatment adherence, require dose reduction or discontinuation, and impact patient quality of life adversely. Because psychiatric illness and SUD comorbidities are so common, patients who have hepatitis C should be screened for these disorders. If these disorders are present, patients should be referred to a mental health care provider for appropriate treatment before therapy with IFNalpha is considered. Having a comanagement model of care that involves mental health care providers should help identify appropriate candidates for IFNalpha therapy. If preexisting depression responds to antidepressant treatment IFNalpha therapy can then be initiated. Patients who have other active psychiatric disorders can probably be offered IFNalpha therapy safely with appropriate monitoring and management involving a mental health care professional; however, there is a paycity of research in this area, and the few published studies have small sample sizes. If depression develops during IFNalpha therapy, most patients respond to treatment with selective serotonin-reuptake inhibitors, often allowing patients to continue receiving IFNalpha therapy. In addition to screening patients and treating those who have psychiatric disorders before IFNalpha therapy is started, early recognition of psychiatric disorders and neuropsychiatric side effects during IRNalpha therapy through continued screening and monitoring, with appropriate management, can potentially maximize HCV treatment adherence and possibly improve antiviral therapy outcomes.