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Management of Depression During Hepatitis C Treatment with Interferon-based Therapy

SUMMARY: Development of depression is common overall in chronic hepatitis C patients treated with interferon, but people with less social support appear to be more susceptible, according to a study reported in the December 2009 American Journal of Gastroenterology. However, the researchers found, people with depression had an equally good chance of achieving sustained response to treatment.

By Liz Highleyman

Donna Evon from the University of North Carolina at Chapel Hill and colleagues performed a study to determine the association between patient characteristics and prevalence of depression before and during interferon-based therapy, and to evaluate the relationship between depression and treatment outcomes.

This prospective study included data from nearly 400 participants (191 African-American and 203 Caucasian) in the Virehep-C study, which was designed to look at differences in treatment response, especially disparities between white and black patients. Numerous studies have shown that people of African descent do not respond as well to interferon-based therapy, but the reasons for this discrepancy are not clear.

Depression was defined as a score of > 23 on the Center for Epidemiologic Studies Depression (CES-D) scale. Scores were obtained before treatment, at weeks 4, 12, and 24 of treatment, and 24 weeks after completion of treatment (the same time frame as determination of rapid, early, and sustained virological response). Social support at baseline was measured using the Medical Outcomes Study (MOS) Social Support Survey.


At baseline, 47 participants (12%) had a CES-D scores > 23.
In a univariate analyses, several patient characteristics were associated with baseline depression, including lower social support scores (P < 0.0001).
Participants with baseline depression were significantly more likely to experience psychiatric adverse events during treatment or start new antidepressant medications (45% vs 28%; P=0.02).
This group was also more likely to discontinue treatment early (38% vs 13%; P < 0.0001).
Sustained virological response (SVR) rates, however, were similar in patients with and without baseline depression (38% vs 40%).
The incidence of new-onset depression was 26% by week 24.
About 33% of patients started antidepressant medication.
None of the participants attempted suicide.
In a multivariate analysis, new-onset depression was significantly associated with younger age (P = 0.04), lower social support (P < 0.001), and reporting "feeling depressed, sad, or blue" (P = 0.008).
Participants who developed depression during treatment were also more likely to experience psychiatric adverse events or begin antidepressants (44% vs 23%; P < 0.001), but were less likely to prematurely discontinue treatment (6% vs 15%; P = 0.02).
Again, patients with new-onset depression during treatment had an SVR rate comparable to that of participants without depression (47% vs 38%).
There were no differences in the frequency of baseline or new-onset depression between African-American and Caucasian patients.

"In this large prospective analysis, baseline and new-onset depression were associated with patient characteristics and treatment outcomes," the study authors concluded, "however, SVR rates did not differ between depressed and non-depressed patients."

"The relationship of lower baseline social support with depressive symptoms warrants further investigation," they recommended.

Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, NC; Epidemiology Data Center, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; Via Research, LLC, Princeton Junction, NJ; Division of Gastroenterology, University of California, San Francisco, CA.


DM Evon, D Ramcharran, SH Belle, and others. Prospective Analysis of Depression During Peginterferon and Ribavirin Therapy of Chronic Hepatitis C: Results of the Virahep-C Study. American Journal of Gastroenterology 104(12): 2949-2958 (Abstract). December 2009.






















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