Clinical Psychiatry News (Nov. 2009) published an article by Drs. Jan Leard-Hansson and Laurence Guttmacher entitled, “Treating Peginterferon-Induced Depression.” In order to determine the best evidence-based antidepressant treatment, the authors reviewed 170 studies but ultimately narrowed these down to 4 to include only randomized controlled trials.
Chronic hepatitis C virus (HCV) infection is not an uncommon health condition among prison inmates. The three most common HCV genotypes that occur in North America are 1, 2, and 3. Genotype 1 is treated with a 48-week course of weekly IM peginterferon and daily oral ribavirin. Types 2 and 3 are treated with a 24-week course. Approximately 1/3 of patients undergoing peginterferon treatment develop depression. Of this 1/3 who develop depression, 3/4 become depressed within the first 8 weeks of treatment.
Anecdotally I have found that citalopram works well for most patients. I have found it fascinating to treat patients with no mental health history who have abruptly developed depression in the context of interferon treatment. (I wish that those who doubt that there is a biological component to depression could witness this phenomenon!)
The authors’ conclusion:
Best available evidence suggests that paroxetine and citalopram prophylactic or symptomatic treatment are effective for peginterferon-induced depression. Conclusions should be tempered by the small sample sizes.
I see this literature review as a helpful start, but clearly there is not enough evidence to make any definite conclusions about what works.
However, I do usually follow some general principles. If a patient has a history of depression, I recommend prophylactic antidepressant treatment. I typically start an SSRI, often citalopram, 2-4 weeks before the initiation of interferon. If patients have no mental health history, then I don’t believe there is enough evidence to suggest prophylactic antidepressant treatment. However, I have a very low threshold for starting an SSRI if such patients begin to develop depressive symptoms.
What do you think? Please share your comments.
Photo Credit: RadsWiki
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