title: Effects of escitalopram prophylaxis during antiviral treatment for chronic hepatitis C in patients with a history of intravenous drug use and depression.
abstract: OBJECTIVE
  We aimed to identify those patients with hepatitis C virus who benefit most from prophylactic treatment with selective serotonin reuptake inhibitors (SSRIs) during antiviral therapy.
  
  
  METHODS
  We performed post hoc analyses on a prospective randomized controlled trial (n = 79) of escitalopram versus placebo during antiviral therapy with pegylated interferon and ribavirin, conducted between August 2005 and June 2008. Our primary outcome measure was the association of baseline characteristics with the development of depression and/or depressive symptoms. Further, we studied effects of prophylactic escitalopram on depressive symptoms. Presence of a major depression was diagnosed using Mini-International Neuropsychiatric Interview (MINI), a short, structured interview used to diagnose DSM-IV-TR and ICD-10 disorders. Depressive symptoms were monitored during treatment by using the depression scale of Symptom Checklist-90 (SCL-90), Montgomery-Asberg Depression Rating Scale (MADRS), and Beck Depression Inventory (BDI) at baseline and weeks 4, 12, and 24 of antiviral therapy.
  
  
  RESULTS
  Depression occurred in 14 patients receiving placebo and in 5 patients receiving escitalopram (Pearson χ², P = .01). Combination of history of depression and intravenous drug use was associated with depression (odds ratio = 12.60; 95% CI, 2.47-64.34; P < .01). Moreover, treatment with selective serotonin reuptake inhibitor compared to placebo was associated with a significant reduction in estimated mean depressive symptoms measured by SCL-90 (P = .03) and BDI (P = .048), but not with MADRS (P = .64).
  
  
  CONCLUSIONS
  Patients infected by hepatitis C virus with a history of depression and intravenous drug use carry the highest risk to develop interferon-induced depression. In this subset of patients, prophylaxis with escitalopram results in the most substantial decrease of interferon-induced depressive symptoms on the SCL-90 depression scale and the BDI.
authors.affiliation: Departments of Gastroenterology and Hepatology the Netherlands.
authors.forename: Daphne M
authors.initials: DM
authors.lastname: Hotho
authors.forename: Geert
authors.initials: G
authors.lastname: Bezemer
authors.forename: Bettina E
authors.initials: BE
authors.lastname: Hansen
authors.forename: Arthur R
authors.initials: AR
authors.lastname: Van Gool
authors.forename: Robert J
authors.initials: RJ
authors.lastname: de Knegt
authors.forename: Harry L A
authors.initials: HL
authors.lastname: Janssen
authors.forename: Bart J
authors.initials: BJ
authors.lastname: Veldt
mesh_terms: D000368:Aged; D000998:Antiviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015283:Citalopram / Q000494:pharmacology*; D015897:Comorbidity; D003863:Depression / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007372:Interferons / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010919:Placebos; D012254:Ribavirin / Q000009:adverse effects* / Q000627:therapeutic use; D017367:Selective Serotonin Reuptake Inhibitors / Q000494:pharmacology*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D015283:Citalopram; D007372:Interferons; D010919:Placebos; D012254:Ribavirin; D017367:Selective Serotonin Reuptake Inhibitors