Prevention of interferon-alpha associated depression in psychiatric risk patients with chronic hepatitis C.
OBJECTIVE
Interferon-alpha (IFN-alpha) induced depression is a major limitation for the treatment of chronic hepatitis C, especially for patients with psychiatric disorders. We prospectively studied the efficacy of a pre-emptive treatment with the antidepressant citalopram to prevent depression during hepatitis C treatment with pegylated IFN-alpha-2b plus ribavirin.


METHODS
14 HCV infected patients with psychiatric disorders received a prophylactic medication with citalopram (20mg/day) before and during therapy with IFN-alpha. The incidence of major depression was compared with 22 HCV infected patients with psychiatric disorders (group B; n=11) and without psychiatric risk factors (group C; n=11), who underwent IFN-alpha treatment without a pre-emptive antidepressant therapy. Depression was diagnosed by DSM-IV criteria.


RESULTS
Pre-treatment of psychiatric patients with citalopram significantly reduced the incidence of major depression during the first 6 months of antiviral treatment as compared to the two control groups (group A 14% vs. 64% and 55% in group B and C; log-rank 6.89; df=2; P=0.032). Patients who developed symptoms of major depression during IFN therapy could also be improved by antidepressive treatment.


CONCLUSIONS
Our open label pilot study, though small, clearly indicates that IFN alpha induced depression in psychiatric risk patients can be ameliorated by both the use of antidepressants as well as by intensive psychiatric care. However, larger, double blind placebo controlled trials in other patient populations are required to confirm these preliminary findings.
Schaefer
Martin
M
Department of Psychiatry, Charité-University Medicine Berlin, Campus Charité Mitte, Schumannstr. 20/21, D-10117 Berlin, Germany. martin.schaefer@charite.de
Schwaiger
Markus
M
Garkisch
Andrea S
AS
Pich
Maurice
M
Hinzpeter
Axel
A
Uebelhack
Ralf
R
Heinz
Andreas
A
van Boemmel
Florian
F
Berg
Thomas
T
D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000008:administration & dosage; D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects*; D015283:Citalopram / Q000008:administration & dosage; D003865:Major Depressive Disorder / Q000139:chemically induced* / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D004359:Drug Therapy, Combination; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts; D011092:Polyethylene Glycols; D011446:Prospective Studies; D011994:Recombinant Proteins; D012254:Ribavirin / Q000008:administration & dosage; D012307:Risk Factors
D018687:Antidepressive Agents, Second-Generation; D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D015283:Citalopram; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b