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Prevention of Depression in Patients Treated for Chronic Hepatitis C Virus Infection With Interferon-alpha FREE

[+] Article and Author Information

The full report is titled “Escitalopram for the Prevention of Peginterferon-α2a–Associated Depression in Hepatitis C Virus–Infected Patients Without Previous Psychiatric Disease. A Randomized Trial.” It is in the 17 July 2012 issue of Annals of Internal Medicine (volume 157, pages 94-103). The authors are M. Schaefer, R. Sarkar, V. Knop, S. Effenberger, A. Friebe, L. Heinze, U. Spengler, T. Schlaepfer, J. Reimer, P. Buggisch, J. Ockenga, R. Link, M. Rentrop, H. Weidenbach, G. Fromm, K. Lieb, T.F. Baumert, A. Heinz, T. Discher, K. Neumann, S. Zeuzem, and T. Berg.


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Ann Intern Med. 2012;157(2):I-40. doi:10.7326/0003-4819-157-2-201207170-00002
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What is the problem and what is known about it so far?

Chronic hepatitis C is a viral infection that may lead to permanent and life-threatening liver damage. It may be effectively treated in many patients with interferon-alpha (IFN-alpha); however, this therapy often causes depression.

Why did the researchers do this particular study?

To see whether using an antidepressant drug before starting IFN-alpha treatment can prevent depression.

Who was studied?

181 patients with hepatitis C virus infection who did not have a history of psychiatric disorders.

How was the study done?

Patients were randomly assigned to receive either the antidepressant drug escitalopram or a placebo pill for 2 weeks before starting IFN-alpha therapy. In addition, the escitalopram or placebo pills were continued throughout the IFN-alpha treatment period, which lasted either 24 or 48 weeks, depending on the type of hepatitis virus that the patients had. A psychiatrist evaluated the patients before, during, and at the end of the study to see whether depression had developed.

What did the researchers find?

Fewer patients who took escitalopram pills before and during IFN-alpha treatment developed clinically relevant depression than those who took placebo pills. In addition, major or severe depression occurred less frequently in the group that received citalopram. There did not seem to be a difference between the escitalopram or placebo groups in how well the antiviral treatment with IFN-alpha worked.

What were the limitations of the study?

Patients with a history of psychiatric disorders (including, for example, previous episodes of depression) were not included, so this study cannot tell us whether escitalopram would prevent depression in these patients. In addition, the study was not large enough to determine what effects, if any, escitalopram had on the IFN-alpha therapy.

What are the implications of the study?

Physicians and patients should discuss whether depression is a concern with IFN-alpha treatment for chronic hepatitis C virus infection and whether it might be prevented.

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