Depression is a major complication during treatment of chronic hepatitis C virus (HCV) infection with interferon-α (IFN-α).
It is unclear whether antidepressants can prevent IFN-induced depression in patients without psychiatric risk factors.
Dr Martin Schaefer and colleagues from Germany examined whether preemptive antidepressant treatment with escitalopram can decrease the incidence or severity of depression associated with pegylated IFN-α in HCV-infected patients without a history of psychiatric disorders.
The team performed a randomized, multicenter, double-blind, prospective, placebo-controlled, parallel-group trial.
The team evaluated 10 university and 11 academic hospitals in Germany.
|32% in the escitalopram group developed a MADRS score of 13 or higher |
|Annals of Internal Medicine|
The research team reported that 181 HCV-infected patients with no history of psychiatric disorders enrolled between 2004 and 2008.
Escitalopram, 10 mg/d, or placebo administered 2 weeks before and for 24 to 48 weeks during antiviral therapy.
The team's primary end point was the incidence of depression, defined as a Montgomery–Asberg Depression Rating Scale (MADRS) score of 13 or higher.
Secondary end points were time to depression, incidence of major depression according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, quality of life, sustained virologic response, tolerability, and safety.
The researchers found that 32% of the patients in the escitalopram group developed a MADRS score of 13 or higher compared with 59% in the placebo group.
The team diagnosed major depression in 8% of the patients in the escitalopram group, and 19% in the placebo group.
The research team observed that tolerability and safety parameters did not differ between the groups.
In the escitalopram group, 56% of patients achieved a sustained virologic response compared with 46% in the placebo group.
Dr Schaefer's team concludes, "Prophylactic antidepressant treatment with escitalopram was effective in reducing the incidence and severity of IFN-associated depression in HCV-infected patients without previous psychiatric disease."