Hyperactivity
of HPA axis in response to interferon-alpha and
development of depression
Rates
of depression are higher in patients
experiencing major medical illness than in the
general population. Interferon-alpha has been
shown to induce depression. A recent study
examined the response of the
hypothalamic-pituitary-adrenal (HPA) axis to
interferon-alpha and evaluated the possible
relationship between this reaction and the
development of major depression during
interferon-alpha treatment.
Fourteen patients with malignant melanoma were
treated with interferon-alpha and plasma levels
of adrenocorticotropic hormone (ACTH), cortisol
and interleukin-6 (IL-6) were measured regularly
during the first 12 weeks of interferon therapy,
immediately before and 1, 2, and 3 hours after
injection of the drug. An assessment of symptom
criteria for major depression was made at each
visit.
The responses of ACTH and cortisol, but not
IL-6, to the first injection of
interferon-alpha, were higher in the seven
patients who subsequently developed major
depression than in those who did not become
depressed. During chronic administration of
interferon-alpha there was no difference in
hormonal or cytokine responses.
The hyperactive response of HPA axis to the
acute administration of interferon-alpha
indicates a fragility of this pathway sytem and
predicts development of depression. It is
therefore highly recommended that depression
prophylaxis be undertaken when patients undergo
surgery, chemotherapy or radiation
treatment. Am
J Psychiatry 160: 1342-1345, 2003