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June 3, 2008
Hepatitis C & Depression

In the United States there are an estimated 4.1 million people infected with hepatitis C virus (HCV). While 15% to 25% of people newly infected will clear the virus spontaneously, the majority will need pharmacologic intervention. Currently the FDA-approved forms of treatment are interferons alfa-2a or -2b (IFN alfa-2a or -2b), which may be covalently bound to polyethylene glycol (peg-IFN alfa), and are typically combined with ribavirin (RBV). Approximately one-third of people receiving therapy will experience treatment-induced depression, which can lead to the need for dose decreases or medication discontinuation. Iatrogenic depression is related to type of treatment, dose, duration, and route of administration.  For instance, the addition of RBV may increase/induce depression, with one investigation finding that depression ratings followed a dose-response relationship.

In general, antidepressants are useful in the alleviation of treatment-induced depression. In one study, patients administered pegIFN alfa-2b + RBV who subsequently developed depression were given citalopram 20 mg/day or placebo. Scores on the Hospital Anxiety and Depression Scale were significantly decreased in the citalopram group, and were significantly lower than placebo patients.

Some suggest that all patients with HCV be administered an antidepressant with IFN treatment, however, as antidepressants themselves have iatrogenic effects this practice is not universally advocated. 
But depression in patients with HCV infection is a common comorbidity of which clinicians need to be aware. It is of utmost importance that all patients are screened for depression before starting HCV therapy and that patients are monitored for symptoms of depression throughout treatment. This may present the need for the setting up and education of multidisciplinary teams involved in separate aspects of HCV and depression treatment.
Further info:
 www.cmeoutfitters.com/CC310. -  for management of HCV infections www.neurosciencecme.com/resources_knowledge_depression.asp. - for further education and resources regarding major depression.
www.neurotransmitter.net/depressionscales.html. - contains a number of depression rating scales is

Other news in this month

- Sleep Apnea Linked to Memory Loss June 27, 2008
- Teen Obesity Tied to death Risks in Middle-Age June 12, 2008
- New Class of Drugs May Fight Alzheimer's by Preventing Buildup of Plaque in the Brain June 12, 2008
- For Hospitalized Heart Failure Patients. June 11, 2008
- Bond Drug (Raloxifene) Prevents ER-Positive Breast Cancer. June 10, 2008
- Hypothermia for Head Trauma in Children June 5, 2008
- Family History of Colorectal Cancer May Improve Chance of Survival June 4, 2008
- Cocoa May Stave Off Cardiovascular Disease in Type 2 Diabetes June 3, 2008
- Hepatitis C & Depression June 3, 2008
- Pituitary Dysfunction Common in Retired Boxers. June 3, 2008
- Mom's Weight Gain May Affect Cleft Palate Risk in Offspring June 1, 2008
-Smoking During Pregnancy Increases Risk of SIDSJune 1, 2008
- Blood Sugar Level Important in Diabetes-Free People. June, 2008
- Periiodontal Disease Increases Cancer Risk June, 2008