Managing depression during hepatitis C treatment.
OBJECTIVE
The prevalence of hepatitis C virus (HCV) infection in Canada is estimated to be 1% and expected to increase during the next decade. Mental illness, particularly depression, is common among HCV-infected patients and remains an obstacle to interferon-alpha (IFN-alpha) treatment. We summarize the risk factors for interferon-alpha-induced major depressive disorder (IFN-alpha-MDD) in HCV patients and the evidence for antidepressant prophylaxis and symptomatic antidepressant treatment of depression.


METHODS
We searched MEDLINE, EMBASE, and CINAHL for randomized controlled or quasi-experimental trials evaluating antidepressant prophylactic and symptomatic treatment approaches for depression emerging during IFN-alpha treatment. Manual searches of references listed in review articles, case series, and anecdotal reports supplemented our literature search.


RESULTS
A total of 9 trials involving prophylactic and symptomatic treatment approaches for IFN-alpha-MDD are summarized in our review. Antidepressant pretreatment is beneficial for patients with elevated baseline depressive symptoms and a preexisting history of IFN-alpha-MDD. Although limited evidence exists for several antidepressant agents, much of the evidence suggests that selective serotonin reuptake inhibitors (SSRIs) are safe and efficacious in treating depressive symptoms secondary to IFN-alpha therapy.


CONCLUSIONS
Both antidepressant pretreatment and symptomatic treatment are viable strategies for treating IFN-alpha-MDD. Improved treatment outcomes and early identification of depression during HCV treatment can be achieved using an integrated medical and mental health treatment approach.
Sockalingam
Sanjeev
S
Program in Medical Psychiatry, Toronto General Hospital, University Health Network, Toronto, Ontario. sanjeev.sockalingam@uhn.on.ca
Abbey
Susan E
SE
D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002170:Canada; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000139:chemically induced* / Q000188:drug therapy* / Q000453:epidemiology; D019317:Evidence-Based Medicine; D006526:Hepatitis C / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D016898:Interferon-alpha / Q000009:adverse effects* / Q000627:therapeutic use; D011292:Premedication; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*
D000928:Antidepressive Agents; D000998:Antiviral Agents; D016898:Interferon-alpha; D017367:Selective Serotonin Reuptake Inhibitors