Therapy of interferon-induced depression in chronic hepatitis C with citalopram: A randomized, double-blind, placebo-controlled study

Michael R Kraus ^1*, Arne Schäfer ¹, Katrin Schöttker ¹, Christian Keicher ¹, Benedikt Weissbrich ², Ingrid Hofbauer ³ and Michael Scheurlen ¹

¹ Medizinische Klinik und Poliklinik II, University of Wuerzburg, Germany
² Institute for Virology and Immunobiology, University of Wuerzburg, Germany
³ Central Pharmacy, University of Wuerzburg, Germany

^* To whom correspondence should be addressed. E-mail: kraus_m{at}klinik.uni-wuerzburg.de.

Accepted 22 November 2007

Abstract

Background:<br> Interferon (IFN) - induced depression represents a major complication in antiviral treatment of chronic hepatitis C virus (HCV) infection.

Aim:<br> To evaluate in a placebo-controlled study the efficacy of a selective serotonin reuptake inhibitor (SSRI) in HCV patients with antiviral therapy and IFN-associated depression.

Methods:<br> In a randomized, double-blind, placebo-controlled study, we included 100 HCV outpatients. During interferon therapy (peginterferon alfa-2b plus ribavirin), depression was monitored using the Hospital Anxiety and Depression Scale (HADS). Patients with clinically relevant IFN-induced depression (HADSâ¥9) were randomly assigned to placebo or citalopram (SSRI, 20 mg/day).

Results:<br> In 28 patients (28%), HADS scores increased to â¥9 during IFN therapy. They were treated with placebo (n=14) or SSRI (n=14). HADS scores declined significantly in SSRI patients within 4 weeks of therapy (P<0.001) but not in placebo patients. This difference between subgroups was statistically significant (P=0.032). Unblinding became necessary in 5 placebo patients due to intolerable depression. Rescue medication (20 mg citalopram) lead to a significant decrease in HADS scores (P=0.008). All citalopram patients were able to complete IFN therapy as planned. Since an interim analysis showed a significant superiority of SSRI over placebo, the study was terminated prematurely. Three patients, who became depressed afterwards, were treated in an unblinded fashion with citalopram.

Conclusions:<br> Our findings demonstrate clearly that citalopram treatment is highly effective in HCV patients on IFN therapy, when initiated after the onset of clinically relevant depressive symptoms. We suggest that a general SSRI prophylaxis is not necessary in these patients.

Keywords: anti-depressant, depression, hepatitis C, placebo-controlled, randomized

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Digest

Robin Spiller and Magnus Simren
Gut 2008 57: 1-2. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Kraus, M R, Schafer, A, Scheurlen, M (2009). Authors' response. Gut 58: 145-146 [Full Text]