Poor sleep quality predicts onset of either major depression or subsyndromal depression with irritability during interferon-alpha treatment

Abstract

Major depressive disorder (MDD) often occurs during pegylated IFN-alpha2 (IFN-alpha) treatment. Identifying who is at risk for MDD in this population is essential, and epidemiological studies suggest that sleep may be related to depression risk. Controlling for pre-existing depression symptoms, we therefore examined whether sleep quality prior to IFN-alpha treatment would predict subsequent MDD incidence during IFN-alpha treatment. Adults with hepatitis C but without current clinical MDD (n=86) were evaluated prior to IFN-alpha treatment and then prospectively monitored during treatment using self-report measures of sleep quality (PSQI), depression (BDI), and anger and irritability (AIAQ), as well as with Structured Clinical Interviews for DSM-IV Axis I Disorders (SCID-I). During IFN-alpha treatment, 19% developed MDD, 19% developed subsyndromal depression with irritability, and one developed mania. Controlling for baseline depression symptoms and past history of depression, patients with worse sleep quality (PSQI > or = 10) prior to treatment had a significantly shorter time until they developed MDD or any severe psychiatric problem. These findings may have important implications for understanding, predicting, and possibly preventing depression, particularly in individuals treated with IFN-alpha.

Figure 1

Kaplan-Meier analysis of the proportion of patients with baseline global PSQI ≥ 10 (poor sleep) and < 10 (good sleep) who required intervention for categorical MDD during the first 16 weeks of combination pegylated-IFN-α2 and ribavirin treatment. ‘o’ denotes cases censored for discontinuing or withholding IFN-α treatment for any medical or psychiatric reason other than MDD.