Interferon alfa (IFN-α)-induced depression is a major limitation for the treatment of chronic hepatitis C, especially for patients with psychiatric disorders. Researchers prospectively studied the efficacy of a pre-emptive treatment with the antidepressant citalopram to prevent depression during hepatitis C treatment with pegylated IFN-α-2b (PegIntron) plus ribavirin.

14 HCV-infected patients with psychiatric disorders received a prophylactic medication with citalopram (20mg/day) before and during therapy with IFN-α. 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-α 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; P=0.032). Patients who developed symptoms of major depression during IFN-therapy could be also improved by anti-depressive treatment.

Conclusions

In conclusion, the authors write, “Our open label pilot study, even small, clearly indicates that IFN alfa-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.”

05/13/05

Reference
M Schaefer and others. Journal of Hepatology 42(6): 799-805. June 2005.

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