Interferon side effects

  I had a blood transfusion in 1974 (about 25 years ago) and was diagnosed with Hepatitis C a little over a year ago.  I have been asymptomatic and biopsy revealed little damage.  AST was 53 and ALT was 92 before starting on combination therapy (interferon 3 MU 3x/week and ribavirin 1000 mg daily)10/98.  Side effects included depression and mood swings, to the point that I had difficulty functioning at work and lack of interest in usual activities.  My gastoenterologist prescribed 20 mg. 1x/daily of Prozac, which seemed to level out my mood, but I still have motivational difficulties along with the usual lack of concentration, minimal memory loss, etc., and am currently on medical leave from work. He referred me to a psychiatrist who recommended continuation of the Prozac along with Ritalin.  I worry that while the Ritalin may give me more energy, it may also increase the cognitive side effects.  Are the current side effects something I need to just accept or should I keep looking for relief?

[HFHSM.D.-D.M.]

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Dear Cindy:
I really appreciated your questions because a lot of your experiences sound similar to those of many of my patients.  It certainly gives me a good opportunity to talk about side effects of interferon therapy.
The cognitive side effects you talk about are common with interferon alone or in combination with ribavirin.  We use prozac and prozac like medications frequently with our patients on interferon and are happy with the results.  I have used ritalin on rare occasions but I do not have a lot of experience with it in patients with hepatitis C.  When using ritalin, it is critical that individuals not have a history of cardiac problems and not have marked anxiety or irritability.  These can get worse.  
We are always reluctant to just tell patients to live with the side effects of therapy but very few patients feel well on interferon.  While I am hesitant to tell you the side effects are something you need to accept, it might give you some solace to hear that your side effects are not out of the ordinary.
One bit of good news is that you have been on treatment for around five months.  In another month, you can do your critical six month PCR.  If your PCR is negative, you will want to continue for another six months but you will get a shot in the arm of knowing you are responding.  
I hope this information is helpful to you. Good luck with your remaining treatment.  If you have additional questions or concerns, I invite you to contact us at Henry Ford.  Our direct phone number is  [phone].   I would also encourage you to visit us at Henry Ford.  We have an active group of liver specialists and we have enormous interest in and experience with hepatitis C.  
This response is being provided for general informational purposes only and should not be considered medical advice or consultation.  Always check with your personal physician when you have a question pertaining to your health.