Escitalopram Does Not Prevent Depression During HCV Treatment With Pegylated Interferon

Escitalopram does not prevent interferon-induced depression

Last Updated: 2010-10-19 10:49:08 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - Escitalopram doesn't prevent depression associated with pegylated interferon alfa-2a treatment of patients with hepatitis C, researchers from Spain report in the Journal of Clinical Psychiatry online October 5th.

"Antidepressants are not useful as a prophylactic tool for all patients, but they are useful in the clinical setting when treating or preventing depression in individual patients," Dr. Crisanto Diez-Quevedo from Autonomous University of Barcelona, Badalona, told Reuters Health in an interview.

Dr. Diez-Quevedo and colleagues evaluated whether pretreatment with the selective serotonin-reuptake inhibitor (SSRI) escitalopram can prevent depression in chronic hepatitis C patients receiving pegylated interferon alfa-2a and ribavirin in a double-blind, randomized trial of 133 patients, 129 of whom actually received the allocated treatment.

"No differences were observed in the development of major depression between those randomized to escitalopram vs placebo," they write. Seven patients (5.4%) developed major depression during the first 12 weeks of antiviral treatment, including 5 of 66 (7.6%) in the escitalopram group and 2 of 63 (3.2%) in the placebo group (P=0.441).

Adverse events occurred with similar frequency in the escitalopram and placebo groups, although muscle and joint pain occurred significantly less often with escitalopram. This is related to the analgesic effects observed for paroxetine in patients receiving high-dose interferon alfa for cancer and also in chronic hepatitis C patients, the authors explain.

There were no serious adverse events.

Taken together, investigators say, these data confirm that chronic hepatitis C patients with no baseline psychiatric distress are unlikely to benefit from antidepressant prophylaxis, probably in contrast to other groups of psychiatric risk patients (with at least moderate scores on depression severity measures at baseline).

"Our hypothesis was that escitalopram would prevent depression induced by interferon," Dr. Diez-Quevedo explained. "In fact, clinical experience follows that. Probably the fact is that distress induced by interferon can be improved with escitalopram and other antidepressants."

He said, however, that in this study the diagnostic criteria of major depression were used and did not capture those with lesser symptoms.

"Other studies have shown similar negative results with paroxetine and citalopram," Dr. Diez-Quevedo said. He concluded that further studies should focus on psychiatric risk patients and other psychopathology such as general distress and irritability.

SOURCE: http://link.reuters.com/xep29p

J Clin Psychiatry 2010.