title: Can antidepressants prevent pegylated interferon-α/ribavirin-associated depression in patients with chronic hepatitis C: meta-analysis of randomized, double-blind, placebo-controlled trials?
abstract: BACKGROUND
  Antidepressants are effective in treating interferon-α/ribavirin (IFN-α/RBV)-associated depression during or after treatment of chronic hepatitis C (CHC). Whether antidepressant prophylaxis is necessary in this population remains under debate.
  
  
  METHODS
  Comprehensive searches were performed in Medline, Embase, Cochrane Controlled Trials Register and PubMed. Reference lists were searched manually. The methodology was in accordance with the 2009 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) Statement.
  
  
  RESULTS
  We identified six randomized, double-blind, placebo-controlled trials involving 522 CHC patients treated with pegylated (PEG)-IFN-α plus RBV. The antidepressants used were escitalopram, citalopram, and paroxetine, which are selective serotonin reuptake inhibitors (SSRIs). The rates of depression (17.9% vs. 31.0%, P = 0.0005), and rescue therapy (27.4% vs. 42.7%, P<0.0001) in the SSRI group were significantly lower than those in the placebo group. The rate of sustained virological response (SVR) (56.8% vs. 50.0%, P = 0.60) and drug discontinuation (18.7% vs. 21.1%, P = 0.63) in the SSRI group did not differ significantly to those in the placebo group. In terms of safety, the incidence of muscle and joint pain (40.8% vs. 52.4%, P = 0.03) and respiratory problems (29.3% vs. 40.1%, P = 0.03) were lower, but the incidence of dizziness was significantly higher (22.3% vs. 10.2%, P = 0.001) in the SSRI group.
  
  
  CONCLUSIONS
  Prophylactic SSRI antidepressants can significantly reduce the incidence of PEG-IFN-α/RBV-associated depression in patients with CHC, with good safety and tolerability, without reduction of SVR.
authors.affiliation: Department of Infectious Diseases, Peking University First Hospital, Peking University, Beijing, People's Republic of China.
authors.forename: Xin-Jiang
authors.initials: XJ
authors.lastname: Hou
authors.forename: Jing-Hang
authors.initials: JH
authors.lastname: Xu
authors.forename: Jun
authors.initials: J
authors.lastname: Wang
authors.forename: Yan-Yan
authors.initials: YY
authors.lastname: Yu
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000009:adverse effects / Q000737:chemistry / Q000627:therapeutic use; D015283:Citalopram / Q000627:therapeutic use; D003863:Depression / Q000139:chemically induced / Q000517:prevention & control*; D004311:Double-Blind Method; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D016898:Interferon-alpha / Q000009:adverse effects / Q000737:chemistry / Q000627:therapeutic use*; D017374:Paroxetine / Q000627:therapeutic use; D011092:Polyethylene Glycols / Q000737:chemistry; D016032:Randomized Controlled Trials as Topic; D012254:Ribavirin / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D000998:Antiviral Agents; D016898:Interferon-alpha; D015283:Citalopram; D011092:Polyethylene Glycols; D017374:Paroxetine; D012254:Ribavirin