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Interferon Causes Major Depression for Hepatitis C Patients

Depression is common and should be treated, study says

TUESDAY, Nov. 26, 2002 (HealthDayNews) -- Interferon therapy, considered the most effective treatment for people who have hepatitis C, causes severe depression in many patients, new research has found.

But doctors at the Portland Veterans Administration (VA) Medical Center, where the study was done, say anti-depressants can alleviate the problem.

In the study of 39 patients with the life-threatening liver disease, one third became severely depressed after several months of interferon therapy and stopped taking their medication. When given an anti-depressant, 85 percent of those who were depressed improved enough to continue their treatment.

"Many people who have hepatitis C have depression, and their depression becomes so uncomfortable they often stop treatment on their own without seeing a physician, or their doctor will stop the interferon," says Dr. Peter Hauser, associate director of the Northwest Hepatitis C Resource Center at the Portland VA Medical Center. "But if they don't stay on the medicine, they don't have the chance to be treated."

Hauser is the lead author of the study, which appears in the November issue of Molecular Psychiatry.

Interferon therapy, combined with an anti-viral agent called ribavirin, is currently the most effective treatment for the disease, which is caused by the hepatitis C virus and which Hauser estimates afflicts approximately four million Americans. It inflames the liver, interfering with its function, which can lead to chronic liver disease like cirrhosis and liver cancer, according to the Mayo Clinic.

There is no vaccine to prevent hepatitis C, and the interferon/ribavirin therapy can help up to 80 percent of those diagnosed with the disease, Hauser says. That's why it's so important that depression not stop people from continuing the treatment, he adds.

"We are looking at a very common side effect, and we need to devote more time and research money to study these side effects, like depression, because if we don't treat the side effects, we won't succeed with treating the disease," he says.

Dr. George Nikias, medical director of the Hepatitis Treatment Center at Hackensack University Medical Center, says that screening for depression among hepatitis C patients is very necessary.

"Studies have been done on this before, and the work is very important. We need to raise the awareness that depression is very common but also very treatable. We're very sensitive to it here," he says.

In Hauser's study, the 39 patients on interferon therapy were monitored for depression on a weekly basis using the Beck Depression Inventory, a standard assessment for depression. Thirteen of the patients developed a major depression after approximately three months of treatment.

Hauser and his colleagues treated them with a selective seretonin reuptake inhibitor (SSRI) called citalopram that goes by the trade name of Celexa. Within an average of five to six weeks, 11 of the patients were no longer depressed, and by an average of nine weeks, the study reported that they were in remission from depression. An SSRI was chosen, Hauser says, because interferon seems to cause seretonin depletion.

Hauser found it significant that the depression occurred at approximately the same time for all the patients.

"There seems to be a threshold effect. The patient will be fine for two or three months, but once the depression starts there is a rapid escalation in its onset, often in a two-week period," he says.

"This suggests that we should be monitoring patients for the treatment of depression every two weeks or no less often than every four weeks."

There was no differences in gender, age, past history of major depression or substance abuse between those who became depressed and those who did not. However, there was significantly less depression among the African-Americans in the study, who represented half the study participants.

Hauser says that African-Americans, who have a much higher prevalence of hepatitis C than do whites, have a very poor response to interferon therapy and there could be a connection between their lack of response to interferon and the low incidence of depression.

The study was initiated by Hauser and his colleagues, and they received grant support for their work from Integrated Therapeutics, a subsidiary of Forest Laboratories, Inc. which manufactures Celexa.

What To Do

A fact sheet on the hepatitis C virus can be found at National Center for Infectious Diseases, and The National Digestive Diseases Information Clearinghouse (NDDIC) has a complete explanation of interferon therapy.

SOURCES: Peter Hauser, M.D., associate director, Northwest Hepatitis C Resource Center, Portland Veterans Administration Medical Center, Oregon; George Nikias, M.D., medical director, Hepatitis Treatment Center, Hackensack University Medical Center, N.J.; November 2002 Molecular Psychiatry
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