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Cited by 169Tryptophan and brain disordersCancer survivorship and careTreatment of Major Depression

Prediction of the Depressive Effects of Interferon Alfa Therapy by the Patient's Initial Affective State

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Capuron, Lucile, Ravaud, Alain·1999·New England Journal of Medicine
DOI 10.1056/nejm199904293401716
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Abstract

To the Editor: The study by Leon et al. (Dec.3 issue) 1 comparing three antithrombotic-drug regimens -aspirin alone, aspirin and warfarin, and aspirin and ticlopidineafter coronary stenting showed a lower rate of stent thrombosis with aspirin and ticlopidine, although there were more hemorrhagic complications than with aspirin alone.By contrast, there were no significant differences in the incidence of neutropenia or thrombocytopenia among the three regimens (overall incidence, 0.3 percent).Despite the absence of severe hematologic dyscrasias in the study, the authors refer to reports of the risk of serious hematologic complications, such as thrombotic thrombocytopenic purpura, among patients who received ticlopidine after coronary stent placement.However, they did not mention the risk of aplastic anemia, a life-threatening condition that may be induced by ticlopidine.Recently, Yeh et al. reviewed the cases of ticlopidine-induced aplastic anemia published in the English literature, 2 and four other cases have been reported 3,4 (including one case reported by us).Ten of 23 patients died (43 percent): 7 because of infection (candidal and gram-negative sepsis) and 1 from massive gastrointestinal bleeding.The only factor significantly correlated with survival was the patients' age.Other factors, such as sex, duration of ticlopidine use, and the presence of agranulocytosis at onset, had no prognostic value. 2 Although the pathogenesis of marrow toxicity related to this drug is still unclear, both direct toxicity and immunologic effects have been proposed. 2The therapeutic use of hematopoietic growth factors has been suggested, 4 but this treatment seems to have little effect on survival. 2,3n summary, although it is an infrequent event, ticlopi-dine-induced marrow aplasia is possible, and patients and doctors should be aware of it.However, aplastic anemia, like other hematologic dyscrasias induced by ticlopidine, appears after 2 weeks of treatment, 2-4 whereas stent thrombosis generally occurs within the first 14 days after coronary stenting (a mean of 0.7 day in the study by Leon et al.). 1 So, we agree with the suggestion made by Leon et al.to shorten the duration of ticlopidine therapy after stenting to two weeks.

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  • Vulnerability to immunotherapy-induced depression involves both psychological and physiological risk factors, as indicated by higher pre-treatment depression scores and enhanced pituitary-adrenal response after first IFN-α injection in patients who developed psychological symptoms.

    “The patients who developed psychological symptoms of depression scored higher on a depression scale before immunotherapy was started51 and had an enhanced pituitary–adrenal response following the first injection of IFN-α52, indicating that vulnerability to immunotherapy-induced depression involves both psychological and physiological risk factors.”

    From From inflammation to sickness and depression: when the immune system subjugates the brain (2008) · cites this paper as [51]

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  1. Opelz G, Sengar DP, Mickey MR, Terasaki PI. Effect of blood trans- fusions on subsequent kidney transplants. Transplant Proc 1973;5:253- 9.
  2. Opelz G. Improved kidney graft survival in nontransfused recipients. Transplant Proc 1987;19:149-52.
  3. Opelz G, Vanrenterghem Y, Kirste G, et al. Prospective evaluation of pretransplant blood transfusions in cadaver kidney recipients. Transplanta- tion 1997;63:964-7.
  4. responsibility; it requires careful consideration of several medical, scientific, and legal issues in which the school or university also has important and legitimate interests. The fundamental relationship between the amateur athlete and the school is consensual, and the law does not create a le- gal right to participate in any activity involving a potential risk of serious injury or sudden death. This view, affirmed by the appellate court in Knapp v. Northwestern University, explicitly supports the legal right of the school and the team physician (as well as the recommendations of the 26th Bethesda Conference 2 ) to disqualify competitive ath- letes with important cardiovascular abnormalities, ulti- mately for the purpose of protecting the health and wel- fare of young sports participants.

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Authors
Capuron, L., & Ravaud, A.
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
1999-04-29
Volume
340
Issue
17
Pages
1370-1370
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejm199904293401716
OpenAlex
W1986891518
Cited by
169
References
4
Citations by year
2025: 1 · 2024: 1 · 2023: 1 · 2022: 2 · 2021: 2 · 2018: 2 · 2017: 4 · 2016: 3 · 2015: 5 · 2014: 3 · 2013: 4 · 2012: 10
FWCI
5.18
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Life Sciences › Neuroscience › Biological Psychiatry › Tryptophan and brain disorders
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Keywords
interferon-alpha therapy, depression, affective states, treatment response prediction, interferon-induced depression
MeSH terms
Adult, Affect, Antineoplastic Agents, Depression, Female, Humans, Male, Melanoma, Psychiatric Status Rating Scales, Interferon-alpha

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