Depression and Improved Treatment Response Rates in Patients with Hepatitis C
P Hauser, Portland VA Medical Center/Oregon Health & Science University, JM Loftis, Portland VA Medical Center/Oregon Health & Science University, AJ Whitehead, Portland VA Medical Center, J Hill, Baltimore VA Medical Center/University of Maryland School of Medicine, CD Howell, Baltimore VA Medical Center/University of Maryland School of Medicine, A Lewy, Oregon Health & Science University
objectives of the present study were to determine the association between IFN-induced
depression and end-of-treatment response (ETR) and sustained viral response (SVR)
rates and to investigate factors associated with increased ETR rates in patients
who developed IFN-induced depression.
patients with HCV were administered the Structured Clinical Interview for DSM-IV
Axis I Disorders (SCID) and completed the Beck Depression Inventory (BDI) prior
to starting IFN therapy. Hepatitis
C genotype and demographic information was obtained for all subjects including
history of major depressive disorder (MDD), history of substance abuse, gender,
race, and weight. During the course
of IFN therapy patients completed BDIs at least weekly, and those patients who
became depressed were treated with citalopram, a selective serotonin reuptake
inhibitor (SSRI) antidepressant.
of 39 patients (33%) developed IFN-induced MDD.
Response rates were significantly higher in those patients who developed
MDD than in those who did not (ETR: 61.5% or 8 of 13 vs. 26.9% or 7 of 26, ÷2 =
4.38, p = 0.03 and SVR: 38% or 5 of 13 vs. 11.5% or 3 of 26; ÷2 = 3.85, p =
0.04). The total change in BDI
score from baseline to peak value was significantly greater in subjects who
responded to IFN therapy, regardless of whether or not they met the diagnostic
criteria for MDD (t = 1.88, p = 0.034). A
one-way ANOVA to assess the effects of body weight on IFN response yielded a
significant difference among the mean weights of patients undergoing IFN therapy
(F = 3.19, p = 0.036). Post hoc
analyses revealed that men who did not respond to IFN therapy weighed more than
men who did achieve ETR. The
association among other patient-related variables such as gender, race, history
of MDD, and history of substance abuse with ETR was not significant.
indicate that: 1) IFN ETR and SVR rates were significantly higher in those
patients who developed IFN-induced MDD than in those who did not; 2) male
patients with ETR to IFN therapy were lighter in body weight than male patients
who did not respond; and 3) gender, race, past history of MDD, and past history
of substance abuse were not significantly associated with ETR.
Impact: Our results suggest that IFN-induced major depressive disorder may be a predictor of a positive response to IFN therapy, or an indication of optimal dosing.