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Fortschr Neurol Psychiatr 2003; 71(9): 469-476
DOI: 10.1055/s-2003-42188
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Interferon-α-assoziierte psychische Nebenwirkungen

Häufigkeit, Ursachen und TherapieIncidence, Pathoetiology and Treatment of Interferon-α induced Neuro-Psychiatric Side EffectsM.  Schäfer1 , M.  Schwaiger1
  • 1Klinik und Poliklinik für Psychiatrie und Psychotherapie (Direktor: Prof. Dr. A. Heinz), Charité, Humboldt-Universität, Berlin
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Publication History

Publication Date:
16 September 2003 (online)

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Zusammenfassung

Interferon-α (IFN-α), ein das Immunsystem stimulierendes Zytokin, hat sich in den letzten Jahren in der Therapie zahlreicher viraler und maligner Erkrankungen durchgesetzt. Neben möglichen somatischen Komplikationen schränken bei dieser Immuntherapie vor allem psychiatrische Nebenwirkungen die Behandlungsmöglichkeiten ein und stellen einen der häufigsten Abbruchgründe für die Therapie dar. Bei ca. 30 - 50 % der behandelten Patienten treten depressive Syndrome, gelegentlich aber auch schwere depressive Syndrome mit Suizidalität auf. Bekannte Depressionen, Suchterkrankungen oder frühere Suizidversuche stellen zudem Kontraindikationen gegen eine Therapie mit IFN-α dar. Daten der letzten Jahre konnten allerdings ein spezifisch erhöhtes Nebenwirkungsrisiko für psychiatrische Patienten nicht bestätigen. Ursachen der psychiatrischen Nebenwirkungen liegen in einer Modulation zentraler Neurotransmitter wie Serotonin, Glutamat und Dopamin, in einer Induktion proinflammatorischer Zytokine und einer Beeinflussung der HPA-Achse. Neben einer ausführlichen Aufklärung ist bei psychiatrischen Patienten eine engmaschige nervenärztliche Mitbetreuung sinnvoll. Unter der Therapie entstehende Einschlafstörungen können mit Zaleplon oder Zolpidem, Durchschlafstörungen z. B. mit Zoplicon oder einem Benzodiazepin behandelt werden. Bei Auftreten einer Depression sollte neben einer engmaschigen psychiatrischen Betreuung frühzeitig eine antidepressive Anbehandlung erfolgen. Als Antidepressiva bieten sich selektive Serotoninwiederaufnahmehemmer wie Citalopram oder Paroxetin an. Mit Mirtazapin steht ein schlafförderndes Antidepressivum zur Verfügung. Bei guter interdisziplinärer Betreuung können auch Patienten mit Risikofaktoren erfolgreich und sicher mit IFN-α behandelt werden. Eine verbesserte Behandlung der psychischen Nebenwirkungen durch informierte Nervenärzte führt somit zu einer besseren Therapieverträglichkeit, einer höheren Haltequote und damit auch zu insgesamt verbesserten Heilungsraten.

Abstract

Interferon α (IFN-α), an immunomodulatory cytokine, is used for the treatment of several disorders including chronic hepatitis or malignant melanoma. During the therapy IFN-α may cause severe neuropsychiatric syndromes including depression with suicidal ideation, paranoid psychoses or confusional states. The reasons and management of these side effects are widely unknown. The underlying pathogenetic mechanisms include various effects on neuroendocrine, cytokine and neurotransmitter systems. This review summarizes therapeutic strategies against IFN-alpha associated psychiatric syndroms. Zolpidem or Zopiclon can be used for the treatment of sleeping disturbances. Serotonin-reuptake-inhibitors including citalopram or paroxetine were shown to be effective for acute treatment of IFN-α associated depression. The efficacy of prophylactic treatment for prevention of IFN-α induced depression has to be proven in future trials. In an interdisciplinary setting, psychiatric disorders and drug addiction should not prevent patients from interferon-alpha treatment. Furthermore, interdisciplinary care should improve quality of life, adherence and therapeutic outcome of interferon-alpha treated patients.

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Dr. med. Martin Schäfer

Klinik für Psychiatrie und Psychotherapie · Charité, Humboldt-Universität zu Berlin

Schumannstr. 20/21

10117 Berlin

Email: martin.schaefer@charite.de

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