I was told and read that Rebif had a huge problem with people who have mental disorders and can and has caused people to commit suicide. Is this true?
The relationship between interferon treatment of MS and depression has been a controversial subject for 20 years. Considered as a class, the Beta Interferons used to treat MS (Avonex, Betaseron, Extavia and Rebif) have been variably associated with a minimal increase in the risk of self reported depression when blinded interferon treated patients are compared to placebo treated patients in clinical trials. There is also very little evidence that interferon treatment of MS patients with current or prior depression worsens depression or causes a recurrence of depression.
David Mohr’s study from many years ago clearly identified current depression as a major cause of interferon discontinuation or poor adherence to therapy; improved adherence to interferon therapy in depressed patients was achieved through early identification and treatment of the depression. To help identify patients at risk for depression, some studies have suggested that people with MS who are younger and with higher levels of disability, particularly women, are more prone to depression.
Suicides have also been reported in interferon treated patients; in fact, there were three suicides in one of the interferon studies involving secondary progressive MS patients. Overall, there does not appear to be an increased risk of suicide, however, in interferon treated patients compared to control treated patients.
Identifying additional factors responsible for depression in people with MS is difficult given the extremely high prevalence of depression in MS. Nearly two thirds of MS patients will experience evidence of depression during the course of their illness; this often occurs early in the course of the illness when the same individuals are often initiating therapies such as interferons. Because of the similarity between early interferon associated side effects (increased fatigue, cognitive blunting, general aches and malaise, disrupted sleep, loss of appetite) and some symptoms of depression, it is important to monitor patients closely for the emergence of depression, particularly during the first 6 months of treatment. I do not avoid interferon use in patients with prior or current depression, but I start treatment for depression before starting interferon in those patients who’s depression is untreated, and monitor the treated patients more closely. Difficulty adhering to therapy is one clue that the patient may have underlying depression. Since this may also affect adherence to other therapies, these individuals should be evaluated for depression or anxiety disorders and, if found, treated with either psychotherapy or antidepressant medications or both.