Secondary Depression Associated to TNF-a Inhibitors

Introduction: A number of adverse drug reactions are known to be associated with Anti TNF alpha drugs; they include infections, injection site reactions, liver function abnormalities, hematological, and solid organ malignancies. Potential psychiatric adverse events have been described only in few cases. Objective: To investigate the relationship between the onset of neuropsychiatric symptoms and the use of anti-TNF alpha drugs. Methods: We describe the case of a patient with no history of psychiatric disorders that experienced secondary depression on anti-TNF alpha with positive rechallenge. Results: A 57-year-old woman was diagnosed with axial ankylosing spondylitis associated with psoriasis and started on etanercept, which was stopped for paradoxical uveitis and substituted with adalimumab, one injection every 15 days. She presented 15 days after the fourth adalimumab infusion, mood disorders with black ideas, negative thoughts, neglect of her appearance and insomnia. These symptoms resolved within 20 days of stopping treatment. She was put under infliximab, and had presented from the first day a recurrence of the depressive syndrome with auditory hallucinations that have disappeared 15 days after stopping this drug. Conclusion: The results suggest that psychiatric disorders may be associated with TNF-α inhibitors. Thus, we draw the attention of clinicians to the possibility of this type of adverse event occurring with this therapeutic class