Clinical

Citalopram effective for interferon-induced depression in hepatitis C

Last Updated: 2008-04-18 10:49:11 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - The selective serotonin reuptake inhibitor (SSRI) citalopram is effective in patients with hepatitis C who develop depression in association with interferon treatment, according to a report by German researchers in the April issue of Gut.

Given the effectiveness of the drug, prophylactic treatment of depression in these patients is not necessary, the researchers add.

Dr. Michael R. Kraus from the University of Wurzburg told Reuters Health, "This is important, because we should bear in mind that the majority of hepatitis C virus (HCV) patients will not develop clinically relevant depression during antiviral treatment."

The investigators studied 100 outpatients with HCV during treatment with peginterferon alfa-2b plus ribavirin. In the 28 patients (28%) who developed depression, Dr. Kraus and associates compared the effectiveness of citalopram vs placebo.

In depressed patients, Hospital Anxiety and Depression Scale (HADS) scores had increased significantly during antiviral treatment but decreased significantly within 4 weeks after initiation of SSRI treatment. Placebo patients showed no significant improvement in HADS scores.

The study was terminated prematurely after a planned interim analysis showed a significant advantage for SSRI treatment.

Open-label citalopram therapy produced a "prompt and significant decrease" in depression scores" in all five patients who failed placebo treatment, the report indicates.

There were no reported side effects that could be attributed to citalopram.

"During antiviral treatment, patients should be evaluated 3-4 times per 6 months," Dr. Kraus said. "Moreover, patients should be encouraged to always report severe depressive symptoms/adverse events at once, irrespective of the planned screening schedule."

"In our view, a general SSRI prophylaxis is not necessary in the absence of specific risk factors for interferon-induced depressive symptoms (e.g., previous therapy with IFN-associated depression)," Dr. Kraus explained.

"As far as the identification of risk factors for interferon-induced depression is concerned, our recent scientific focus is on molecular genetics," Dr. Kraus added. "We have found a significant impact of allelic variation in 5-HT(1A) receptor expression on the development of interferon-induced depression during antiviral treatment of chronic hepatitis C."

Gut 2008;57:531-536.