Prophylactic Treatment for Depression with Interferon Therapy for Chronic Hepatitis C

Among HCV-infected adults without previous psychiatric disease, prophylactic antidepressant use significantly decreased the incidence and severity of interferon-associated depression.

Up to 40% of patients who receive interferon-based therapy for hepatitis C virus (HCV) infection develop major depression. Data from previous studies support the use of antidepressants in interferon recipients with preexisting psychiatric risk factors, but little is known about the prophylactic use of such agents in patients without previous psychiatric disease. Now, researchers in Germany (with partial industry support) have conducted a multicenter, double-blind study to explore this issue.

Treatment-naive HCV-infected adults without a history of psychiatric disorders were randomized to receive escitalopram (10 mg daily) or placebo. During a 12-week preobservation period, they were monitored for depression unrelated to antiviral treatment. They then received the study drug for 2 weeks before initiation of interferon therapy — peginterferon alfa-2a (180 µg weekly) and ribavirin (800–1200 mg daily) for 24 or 48 weeks, based on HCV genotype. Escitalopram or placebo was continued throughout HCV therapy.

A total of 181 patients were included in the analyses. Thirty-two percent of the escitalopram group and 59% of the placebo group developed depression (defined as a Montgomery–Asberg Depression Rating Scale score 13) during antiviral therapy (P<0.001). The depression was classified as major (according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) in 8% of the escitalopram group and 19% of the placebo group (P=0.031). However, early discontinuation of HCV therapy — including that caused by psychiatric events — was similar between groups (5 patients each). Sustained virologic response rates were also similar between groups: 56% and 46%, respectively (P=0.21).

CITATION(S):

Schaefer M et al. Escitalopram for the prevention of peginterferon-?2a–associated depression in hepatitis C virus–infected patients without previous psychiatric disease: A randomized trial. Ann Intern Med 2012 Jul 17; 157:94.