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Peginterferon Alfa plus ribavirin is the standard treatment for patients with chronic hepatitis C, but depression and other psychiatric adverse events are common complications of interferon treatment. Previous trials on depression prophylaxis with antidepressants have shown inconsistent results but most of these trials have been limited by either small sample size or short follow-up duration. In the largest trial to date, prophylactic escitalopram (Lexapro, Cipralex) was evaluated in adults with chronic hepatitis C and no history of psychiatric illness. A total of 208 patients were randomized to receive escitalopram 10 mg once daily vs. placebo beginning 2 weeks before the initiation of antiviral treatment with peginterferon alfa-2A plus ribavirin. Antiviral therapy lasted for 24 or 48 weeks depending upon genotype. Escitalopram treatment continued for the duration of antiviral therapy. Patients were followed for incident depression for 48-72 weeks (24 weeks after end of treatment).
All patients were observed for development of depressive symptoms for 12 weeks prior to the start of allocated treatment. During this period, 17% of the escitalopram group and 9% of the placebo group dropped out. The remaining 181 patients were included in the analysis, including 9 patients who were lost to follow-up.
Depression was defined as a score of ≥ 13 points on the Montgomery-Asberg Depression Rating Scale (MADRS, range 0-60 points). Depression developed in 32% with escitalopram vs. 59% with placebo (p
< 0.001, NNT 4) (level 2 [mid-level] evidence). Major depression, defined by criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV developed in 8% vs. 19% (p = 0.031, NNT 9). There were no significant differences in sustained virologic response, treatment discontinuation, or serious adverse events (Ann Intern Med 2012 Jul 17;157(2):94). Peginterferon treatment is contraindicated in patients with preexisting depression or other psychiatric illness.
For more information see the Hepatitis C and Peginterferon Alfa topics in DynaMed.