A randomized trial of paroxetine to prevent interferon-α-induced depression in patients with hepatitis C

Benjamin Morasco, Muhamad Aly Rifai, Jennifer Loftis, David W. Indest, James Kelly Moles, Peter Hauser

Research output: Contribution to journalArticle

85 Citations (Scopus)

Abstract

Background: Interferon-α-(IFN-α) induced depression presents a challenge when treating patients with the hepatitis C virus (HCV). Depression occurs in approximately one-third of patients during antiviral therapy and can lead to reduction in treatment dosage or discontinuation of treatment, thus reducing the likelihood of clearing HCV infection. This study examined the efficacy of paroxetine in preventing the development of depression during antiviral therapy. Methods: In a double-blind, placebo-controlled study, 33 patients with HCV were randomly assigned to paroxetine or placebo prior to antiviral therapy. Patients were evaluated for psychiatric symptoms prior, during, and six months after antiviral therapy. Results: The rate of IFN-α-induced depression for the entire sample was 33.3%. The prophylactic use of paroxetine did not decrease the likelihood of IFN-α-induced depression (35.7% in the paroxetine group vs. 31.6% in the placebo group). However, in 10 of 11 patients who developed IFN-α-induced depression and entered the rescue arm of the study, open-label treatment with paroxetine helped reduce symptoms of depression. Group assignment did not appear to impact antiviral therapy completion rates, as a similar proportion of patients from each group completed treatment. Limitations: The antiviral treatment was changed during the trial and aspects of the sample limit the generalizability of the results. Conclusion: A prophylactic approach to interferon-α-induced depression may not be indicated in patients with HCV infection.

Original languageEnglish (US)
Pages (from-to)83-90
Number of pages8
JournalJournal of Affective Disorders
Volume103
Issue number1-3
DOIs
StatePublished - Nov 2007

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Paroxetine
Hepatitis C
Interferons
Antiviral Agents
Hepacivirus
Therapeutics
Placebos
Virus Diseases
Psychiatry

Keywords

  • Antiviral therapy
  • Depression
  • Hepatitis C
  • Interferon
  • Prevention
  • Viral response

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Behavioral Neuroscience
  • Biological Psychiatry
  • Neurology
  • Psychology(all)

Cite this

A randomized trial of paroxetine to prevent interferon-α-induced depression in patients with hepatitis C. / Morasco, Benjamin; Rifai, Muhamad Aly; Loftis, Jennifer; Indest, David W.; Moles, James Kelly; Hauser, Peter.

In: Journal of Affective Disorders, Vol. 103, No. 1-3, 11.2007, p. 83-90.

Research output: Contribution to journalArticle

Morasco, Benjamin ; Rifai, Muhamad Aly ; Loftis, Jennifer ; Indest, David W. ; Moles, James Kelly ; Hauser, Peter. / A randomized trial of paroxetine to prevent interferon-α-induced depression in patients with hepatitis C. In: Journal of Affective Disorders. 2007 ; Vol. 103, No. 1-3. pp. 83-90.
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abstract = "Background: Interferon-α-(IFN-α) induced depression presents a challenge when treating patients with the hepatitis C virus (HCV). Depression occurs in approximately one-third of patients during antiviral therapy and can lead to reduction in treatment dosage or discontinuation of treatment, thus reducing the likelihood of clearing HCV infection. This study examined the efficacy of paroxetine in preventing the development of depression during antiviral therapy. Methods: In a double-blind, placebo-controlled study, 33 patients with HCV were randomly assigned to paroxetine or placebo prior to antiviral therapy. Patients were evaluated for psychiatric symptoms prior, during, and six months after antiviral therapy. Results: The rate of IFN-α-induced depression for the entire sample was 33.3{\%}. The prophylactic use of paroxetine did not decrease the likelihood of IFN-α-induced depression (35.7{\%} in the paroxetine group vs. 31.6{\%} in the placebo group). However, in 10 of 11 patients who developed IFN-α-induced depression and entered the rescue arm of the study, open-label treatment with paroxetine helped reduce symptoms of depression. Group assignment did not appear to impact antiviral therapy completion rates, as a similar proportion of patients from each group completed treatment. Limitations: The antiviral treatment was changed during the trial and aspects of the sample limit the generalizability of the results. Conclusion: A prophylactic approach to interferon-α-induced depression may not be indicated in patients with HCV infection.",
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