A multidisciplinary therapeutic approach for reducing the risk of psychiatric side effects in patients with chronic hepatitis C treated with pegylated interferon α and ribavirin.
OBJECTIVE
To evaluate the effectiveness of psychiatric counseling in reducing the rate of development of psychiatric side effects of antiviral therapy with interferon-α and ribavirin among study participants compared with standard clinical monitoring alone.


BACKGROUND
Interferon-α is used to treat chronic hepatitis C. Interferons may induce adverse events that usually, but not always, reverse within a few days after the end of therapy.


METHODS
Two hundred eleven patients with chronic hepatitis C, genotype 1b were treated with peginterferon and ribavirin for 48 weeks in a prospective trial. Two groups were randomly created. Group A was interviewed by a team of gastroenterologists, psychiatrists, and psychologists and treated with psychotherapy once a month. Group B was monitored once a month according to a conventional protocol that did not include psychotherapy. SVR (sustained viral response), severe psychiatric symptom onset, and mood progression were assessed (P calculated using Fisher exact test, Friedman test, Dunn posttest, and Mann-Whitney U-test).


RESULTS
At baseline, there was no difference in depressive symptoms or liver histologic score between the 2 groups. The onset rate of severe psychiatric manifestations was 4.7% (Group A) and 16.1% (Group B) between the 24th and 36th weeks (P<0.01). Fifteen participants in Group A and 39 in Group B required antidepressants and benzodiazepines (P<0.05).


CONCLUSIONS
Patients can develop depressive symptoms during interferon therapy. Multidisciplinary medical treatment with psychiatric counseling provided during the treatment of chronic hepatitis C may contribute to the decrease or prevent the higher rates of depression associated with interferon treatment.
Neri
Sergio
S
Department of Internal Medicine, University of Catania, Italy. sergio.neri4@tin.it
Bertino
Gaetano
G
Petralia
Antonio
A
Giancarlo
Crisafulli
C
Rizzotto
Agostino
A
Calvagno
Giuseppe Stefano
GS
Mauceri
Barbara
B
Abate
Giuseppe
G
Boemi
Patrizia
P
Di Pino
Antonino
A
Ignaccolo
Luca
L
Vadalà
Giuseppe
G
Misseri
Maria
M
Maiorca
Daniela
D
Mastrosimone
Gianluca
G
Judica
Antonino
A
Palermo
Filippo
F
D000998:Antiviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003863:Depression / Q000139:chemically induced / Q000517:prevention & control*; D016903:Drug Monitoring / Q000379:methods; D004359:Drug Therapy, Combination; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000009:adverse effects* / Q000627:therapeutic use; D011446:Prospective Studies; D011613:Psychotherapy / Q000379:methods; D011994:Recombinant Proteins; D012254:Ribavirin / Q000009:adverse effects* / Q000627:therapeutic use; D012720:Severity of Illness Index
D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b