Prophylactic antidepressant treatment of interferon-induced depression in chronic hepatitis C: a systematic review and meta-analysis.
J. Clin. Psychiatry. 2014-10-28; 75(10): e1113-e1121
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1. J Clin Psychiatry. 2014 Oct;75(10):e1113-21. doi: 10.4088/JCP.13r08800.
Prophylactic antidepressant treatment of interferon-induced depression in chronic
hepatitis C: a systematic review and meta-analysis.
Udina M(1), Hidalgo D, Navinés R, Forns X, Solà R, Farré M, Capuron L, Vieta E,
(1)Department of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, CIBERSAM;
and Department of Psychiatry and Clinical Psychobiology, Universitat de
OBJECTIVE: To assess the utility of prophylactic administration of
antidepressants in preventing a major depressive episode during antiviral
treatment for chronic hepatitis C.
DATA SOURCES: A computerized literature search was conducted in MEDLINE,
PsycINFO, EMBASE, the Cochrane Library, and ClinicalTrials.gov to locate articles
published in any language from the earliest available online year until October
2012, using the following phrase and Boolean logic algorithm: « hepatitis and c
and (interferon-alpha OR peginterferon OR (pegylated and interferon)) and
(depression OR mood) and (prevention OR prophylactic OR prophylaxis OR
STUDY SELECTION: Double-blind, randomized, placebo-controlled trials using
antidepressants prophylactically before starting antiviral therapy for chronic
hepatitis C were included. At baseline, none of the patients in the trials
presented depression (DSM-IV-TR criteria). Using keywords and cross-referenced
bibliographies, 144 studies were identified and examined in depth. 137 articles
were rejected because inclusion criteria were not met. Finally, 7 studies were
DATA EXTRACTION: Data were extracted independently by 2 investigators. The
primary outcome measure was the onset of a major depressive episode during the
antiviral treatment. Depressive symptoms, other side effects, and sustained
virologic response were also examined. A full review and meta-analysis were
performed. Odds ratios (ORs), mean differences, and estimated numbers needed to
treat (NNTs) with 95% confidence intervals (CIs) were calculated.
RESULTS: 591 patients were randomly assigned to antiviral treatment and another
intervention: escitalopram (n = 197), paroxetine (n = 42), citalopram (n = 53),
or placebo (n = 299). Selective serotonin reuptake inhibitors (SSRIs), as a
group, reduced the incidence of a major depressive episode during antiviral
treatment (OR = 0.53; 95% CI, 0.33 to 0.84). The NNT was 12 (95% CI, 7.0 to
37.9). SSRIs reduced depressive symptoms at 24 weeks of treatment (mean
difference -2.18; 95% CI, -4.25 to -0.10). With regard to side effects, only
dizziness was associated with administration of antidepressants (OR = 2.65; 95%
CI, 1.46 to 4.80). There were no differences in sustained virologic response (OR
= 1.22; 95% CI, 0.58 to 2.57).
CONCLUSIONS: Administration of SSRIs before starting antiviral treatment reduces
the incidence of interferon-induced depression, with a relatively moderate
prophylactic impact and good tolerability.
© Copyright 2014 Physicians Postgraduate Press, Inc.
PMID: 25373120 [Indexed for MEDLINE]