An open-label trial of citalopram for major depression in patients with hepatitis C.
BACKGROUND
Hepatitis C affects nearly 4 million Americans. Depression is a common comorbid condition in this population and may be induced by interferon alfa, an approved treatment for hepatitis C. Depression is a major indicator for discontinuation of interferon therapy. This open-label study examines the effect of citalopram on measures of depression and quality of life and tests of liver function in subjects with hepatitis C and major depressive disorder.


METHODS
Subjects were recruited by advertisement; those with DSM-IV major depressive disorder were included in the study. Subjects received citalopram for 8 weeks starting at 20 mg/day. Dosage adjustments were made as the physicians deemed clinically necessary. No dosages were increased prior to week 4 of the study. Hamilton Rating Scale for Depression (HAM-D) scores, Clinical Global Impressions-Severity of Illness scale (CGI-S) scores, Medical Outcomes Study Short Form Health Survey (SF-36) ratings, Symptom Checklist-90-Revised (SCL-90-R) scores, and liver function tests were obtained at baseline, 4 weeks, and 8 weeks.


RESULTS
A total of 15 patients (10 men, 5 women) participated in this study. The mean daily dose of citalopram at endpoint was 26.67 mg. Mean HAM-D scores decreased significantly with treatment (F = 36.3, df = 2,42; p = .0001). Thirteen of the 15 subjects demonstrated a clinical response, defined as a 50% or greater reduction in HAM-D scores. CGI-Severity of Illness scores also improved significantly (p = .0001). Subjects demonstrated statistically significant improvement (p < .05) on all of the SF-36 subscales. Statistically significant improvements (p < .05) were also demonstrated on all subscales of the SCL-90-R. Tests of liver function showed no significant worsening of aspartate aminotransferase, alanine aminotransferase, or gamma-glutamyltransferase levels.


CONCLUSIONS
These results suggest that depression in patients with hepatitis C may be effectively and safely treated with citalopram.
Gleason
Ondria C
OC
Department of Psychiatry, University of Oklahoma College of Medicine-Tulsa, 74135-2512, USA. ondria-gleason@ouhsc.edu
Yates
William R
WR
Isbell
M Daniel
MD
Philipsen
Michelle A
MA
D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000378:metabolism; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects / Q000627:therapeutic use*; D001219:Aspartate Aminotransferases / Q000378:metabolism; D015283:Citalopram / Q000009:adverse effects / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D006526:Hepatitis C / Q000150:complications* / Q000201:enzymology; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D005723:gamma-Glutamyltransferase / Q000378:metabolism
D000410:Alanine Transaminase; D018687:Antidepressive Agents, Second-Generation; D001219:Aspartate Aminotransferases; D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors; D005723:gamma-Glutamyltransferase