Managing Depression during Hepatitis C Treatment

Objective: The prevalence of hepatitis C virus (HCV) infection in Canada is estimated to be 1% and expected to increase during the next decade. Mental illness, particularly depression, is common among HCV-infected patients and remains an obstacle to interferon-alpha (IFN-α) treatment. We summarize the risk factors for interferon-α–induced major depressive disorder (IFN-α–MDD) in HCV patients and the evidence for antidepressant prophylaxis and symptomatic antidepressant treatment of depression. Methods: We searched MEDLINE, EMBASE, and CINAHL for randomized controlled or quasi-experimental trials evaluating antidepressant prophylactic and symptomatic treatment approaches for depression emerging during IFN-α treatment. Manual searches of references listed in review articles, case series, and anecdotal reports supplemented our literature search. Results: A total of 9 trials involving prophylactic and symptomatic treatment approaches for IFN-α–MDD are summarized in our review. Antidepressant pretreatment is beneficial for patients with elevated baseline depressive symptoms and a preexisting history of IFN-α–MDD. Although limited evidence exists for several antidepressant agents, much of the evidence suggests that selective serotonin reuptake inhibitors (SSRIs) are safe and efficacious in treating depressive symptoms secondary to IFN-α therapy. Conclusion: Both antidepressant pretreatment and symptomatic treatment are viable strategies for treating IFN-α–MDD. Improved treatment outcomes and early identification of depression during HCV treatment can be achieved using an integrated medical and mental health treatment approach.

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Symptom Cluster-Matching Antidepressant Treatment: A Case Series Pilot Study

Pharmaceuticals ◽

10.3390/ph14060526 ◽

2021 ◽

Vol 14 (6) ◽

pp. 526

Author(s):

Sławomir Murawiec ◽

Marek Krzystanek

Keyword(s):

Depressive Symptoms ◽

Pilot Study ◽

Antidepressant Treatment ◽

Case Series ◽

Symptom Cluster ◽

Study Results ◽

Cluster Matching ◽

The Individual ◽

Meta Analyses ◽

Effectiveness Studies

Despite treating depression with antidepressants, their effectiveness is often insufficient. Comparative effectiveness studies and meta-analyses show the effectiveness of antidepressants; however, they do not provide clear indications as to the choice of a specific antidepressant. The rational choice of antidepressants may be based on matching their mechanisms of action to the symptomatic profiles of depression, reflecting the heterogeneity of symptoms in different patients. The authors presented a series of cases of patients diagnosed with depression in whom at least one previous antidepressant treatment was shown to be ineffective before drug targeted symptom cluster-matching treatment (SCMT). The presented pilot study shows for the first time the effectiveness of SCMT in the different clusters of depressive symptoms. All the described patients obtained recovery from depressive symptoms after introducing drug-targeted SCMT. Once validated in clinical trials, SCMT might become an effective and rational method of selecting an antidepressant according to the individual profile of depressive symptoms, the mechanism of their formation, and the mechanism of drug action. Although the study results are preliminary, SCMT can be a way to personalize treatment, increasing the likelihood of improvement even in patients who meet criteria for treatment-resistant depression.

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Depression, depressive symptoms and treatments in women who have recently given birth: UK cohort study

BMJ Open ◽

10.1136/bmjopen-2018-022152 ◽

2018 ◽

Vol 8 (10) ◽

pp. e022152 ◽

Cited By ~ 8

Author(s):

Irene Petersen ◽

Tomi Peltola ◽

Samuel Kaski ◽

Kate R Walters ◽

Sarah Hardoon

Keyword(s):

Primary Care ◽

Cohort Study ◽

Depressive Symptoms ◽

Electronic Health Records ◽

Postnatal Depression ◽

Selective Serotonin Reuptake Inhibitors ◽

Antidepressant Treatment ◽

Health Records ◽

Electronic Health ◽

Ssri Treatment

ObjectivesTo investigate how depression is recognised in the year after child birth and treatment given in clinical practice.DesignCohort study based on UK primary care electronic health records.SettingPrimary care.ParticipantsWomen who have given live birth between 2000 and 2013.OutcomesPrevalence of postnatal depression, depression diagnoses, depressive symptoms, antidepressant and non-pharmacological treatment within a year after birth.ResultsOf 206 517 women, 23 623 (11%) had a record of depressive diagnosis or symptoms in the year after delivery and more than one in eight women received antidepressant treatment. Recording and treatment peaked 6–8 weeks after delivery. Initiation of selective serotonin reuptake inhibitors (SSRI) treatment has become earlier in the more recent years. Thus, the initiation rate of SSRI treatment per 100 pregnancies (95% CI) at 8 weeks were 2.6 (2.5 to 2.8) in 2000–2004, increasing to 3.0 (2.9 to 3.1) in 2005–2009 and 3.8 (3.6 to 3.9) in 2010–2013. The overall rate of initiation of SSRI within the year after delivery, however, has not changed noticeably. A third of the women had at least one record suggestive of depression at any time prior to delivery and of these one in four received SSRI treatment in the year after delivery.Younger women were most likely to have records of depression and depressive symptoms. (Relative risk for postnatal depression: age 15–19: 1.92 (1.76 to 2.10), age 20–24: 1.49 (1.39 to 1.59) versus age 30–34). The risk of depression, postnatal depression and depressive symptoms increased with increasing social deprivation.ConclusionsMore than 1 in 10 women had electronic health records indicating depression diagnoses or depressive symptoms within a year after delivery and more than one in eight women received antidepressant treatment in this period. Women aged below 30 and from the most deprived areas were at highest risk of depression and most likely to receive antidepressant treatment.

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Promoter Polymorphisms of the Interferon-α Receptor Gene and Development of Interferon-Induced Depressive Symptoms in Patients with Chronic Hepatitis C: Preliminary Findings

Neuropsychobiology ◽

10.1159/000086605 ◽

2005 ◽

Vol 52 (2) ◽

pp. 55-61 ◽

Cited By ~ 26

Author(s):

Keizo Yoshida ◽

Oyetunde Alagbe ◽

Xiaohong Wang ◽

Bobbi Woolwine ◽

Marie Thornbury ◽

...

Keyword(s):

Chronic Hepatitis ◽

Depressive Symptoms ◽

Hepatitis C ◽

Chronic Hepatitis C ◽

Receptor Gene ◽

Interferon Α ◽

Promoter Polymorphisms

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Early prediction of major depression in chronic hepatitis C patients during peg-interferon α-2b treatment by assessment of vegetative-depressive symptoms after four weeks

World Journal of Gastroenterology ◽

10.3748/wjg.v13.i43.5736 ◽

2007 ◽

Vol 13 (43) ◽

pp. 5736 ◽

Cited By ~ 12

Author(s):

Geert Robaeys

Keyword(s):

Chronic Hepatitis ◽

Depressive Symptoms ◽

Hepatitis C ◽

Major Depression ◽

Chronic Hepatitis C ◽

Interferon Α ◽

Early Prediction ◽

Chronic Hepatitis C Patients

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Antidepressant use and work-related injuries

Psychological Medicine ◽

10.1017/s0033291715002925 ◽

2016 ◽

Vol 46 (7) ◽

pp. 1391-1399 ◽

Cited By ~ 1

Author(s):

A. Kouvonen ◽

J. Vahtera ◽

J. Pentti ◽

M. J. Korhonen ◽

T. Oksanen ◽

...

Keyword(s):

Confidence Interval ◽

Rate Ratio ◽

Injury Risk ◽

Selective Serotonin Reuptake Inhibitors ◽

Antidepressant Treatment ◽

Case Series ◽

Work Related ◽

Work Related Injury ◽

Increased Risk ◽

Antidepressant Use

BackgroundAdverse effects of antidepressants are most common at the beginning of the treatment, but possible also later. We examined the association between antidepressant use and work-related injuries taking into account the duration of antidepressant use.MethodAntidepressant use and work-related injuries between 2000 and 2011 were measured among 66 238 employees (mean age 43.8 years, 80% female) using linkage to national records (the Finnish Public Sector study). We analysed data using time-dependent modelling with individuals as their own controls (self-controlled case-series design).ResultsIn 2238 individuals who had used antidepressants and had a work-related injury during a mean follow-up of 7.8 years, no increase in the risk of injury was observed in the beginning of antidepressant treatment. However, an increased injury risk was seen after 3 months of treatment (rate ratio, compared with no recent antidepressant use, 1.27, 95% confidence interval 1.10–1.48). This was also the case among those who had used only selective serotonin reuptake inhibitors (n = 714; rate ratio 1.41, 95% confidence interval 1.08–1.83).ConclusionsAntidepressant use was not associated with an increased risk of work-related injury at the beginning of treatment. Post-hoc analyses of antidepressant trials are needed to determine whether long-term use of antidepressants increases the risk of work-related injury.

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Interferon-α induces negative biases in emotional processing in patients with hepatitis C virus infection: a preliminary study

Psychological Medicine ◽

10.1017/s0033291717002379 ◽

2017 ◽

Vol 48 (6) ◽

pp. 998-1007 ◽

Cited By ~ 10

Author(s):

C. M. Cooper ◽

B. Godlewska ◽

A. L. Sharpley ◽

E. Barnes ◽

P. J. Cowen ◽

...

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Virus Infection ◽

Emotional Processing ◽

Rating Scales ◽

Depressive Symptomatology ◽

Antidepressant Treatment ◽

Interferon Α ◽

Hepatitis C Virus Infection ◽

Preliminary Study

BackgroundTreatment of medical patients with the inflammatory cytokine, interferon-α (IFN-α), is frequently associated with the development of clinical depressive symptomatology. Several important biological correlates of the effect of IFN-α on mood have been described, but the neuropsychological changes associated with IFN-α treatment are largely unexplored. The aim of the present preliminary study was to assess the effect of IFN-α on measures of emotional processing.MethodWe measured changes in emotional processing over 6–8 weeks in 17 patients receiving IFN-α as part of their treatment for hepatitis C virus infection. Emotional processing tasks included those which have previously been shown to be sensitive to the effects of depression and antidepressant treatment, namely facial expression recognition, emotional categorisation and the dot probe attentional task.ResultsFollowing IFN-α, patients were more accurate at detecting facial expressions of disgust; they also showed diminished attentional vigilance to happy faces. IFN-α produced the expected increases in scores on depression rating scales, but there was no correlation between these scores and the changes in emotional processing.ConclusionsOur preliminary findings suggest that IFN-α treatment produces negative biases in emotional processing, and this effect is not simply a consequence of depression. It is possible that increased recognition of disgust may represent a neuropsychological marker of depressive disorders related to inflammation.

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