Jennifer M. Loftis is supported by a Career Development Award from the Veterans Health Administration and by grant support from the National Institute on Drug Abuse. Benjamin J. Morasco receives support from the National Institute on Drug Abuse (K23DA023467). Peter Hauser receives grant support from the VA Research Merit Review Program of the Veterans Health Administration.
Article first published online: 10 JAN 2011
Copyright © 2010 American Association for the Study of Liver Diseases
Volume 53, Issue 4, pages 1413–1414, April 2011
How to Cite
Loftis, J. M., Morasco, B. J. and Hauser, P. (2011), Depression and antiviral response to interferon-based therapy for hepatitis C virus infection. Hepatology, 53: 1413–1414. doi: 10.1002/hep.24064
Potential conflict of interest: Nothing to report.
- Issue published online: 7 APR 2011
- Article first published online: 10 JAN 2011
- Accepted manuscript online: 4 NOV 2010 07:54AM EST
- Manuscript Received: 26 OCT 2010
- Manuscript Accepted: 26 OCT 2010
To the Editor:
Within the context of published literature on interferon (IFN)-induced depression and hepatitis C virus, Leutscher et al.1 highlighted the complex relationships of mood, IFN, antidepressants, and sustained virological response (SVR). In agreement with previous studies, Leutscher et al. found that approximately 30% of patients receiving IFN-based therapy developed major depressive disorder (MDD). They also reported that IFN-induced depression was associated with a reduced likelihood of achieving SVR and stated that their study was the first to report this relationship. However, research has addressed this controversial topic.2-6 A prospective study (n = 394) analyzed the relationship between baseline and new-onset depression and treatment outcomes, and the SVR rates did not differ between patients who developed MDD and those who did not.6 Our retrospective cohort study supports and extends these findings by comparing the rates of antiviral therapy completion and SVR between patients with hepatitis C virus and MDD and those without MDD.7 We found that the MDD group had completion and SVR rates similar to those of patients without MDD. In our study, all patients with MDD were on antidepressant medications before and during antiviral therapy.
Untreated IFN-induced depression may lead to dose reductions, premature IFN therapy termination, and compromised treatment outcomes. Leutscher et al.1 reported that almost half of their patients with MDD did not receive psychotropic medication and that their study was insufficiently powered to evaluate whether antidepressants affected viral clearance. Previous literature has shown that careful monitoring of neuropsychiatric symptoms during antiviral therapy and the initiation of antidepressants if significant symptoms of depression develop can be an effective strategy for optimizing treatment outcomes in patients with hepatitis C virus.
- 1Evaluation of depression as a risk factor for treatment failure in chronic hepatitis C. Hepatology 2010; 52: 430-435., , , , , , et al.
- 2Depressive symptoms and viral clearance in patients receiving interferon-alpha and ribavirin for hepatitis C. Brain Behav Immun 2005; 19: 23-27., , , , , , et al.
- 3Psychopathological symptoms during interferon-alpha and ribavirin treatment: effects on virologic response. Mol Psychiatry 2005; 10: 332-333., , , , , , et al.
- 4Association of interferon-alpha-induced depression and improved treatment response in patients with hepatitis C. Neurosci Lett 2004; 365: 87-91., , , , , , et al.
- 5Impact of depressive symptoms and their treatment on completing antiviral treatment in patients with chronic hepatitis C. J Clin Gastroenterol 2010; 44: e178-e185., , , , , , et al.
- 6Prospective analysis of depression during peginterferon and ribavirin therapy of chronic hepatitis C: results of the Virahep-C study. Am J Gastroenterol 2009; 104: 2949-2958., , , , , , et al.
- 7Antiviral completion rates and sustained viral response in hepatitis C patients with and without preexisting major depressive disorder. Psychosomatics 2009; 50: 500-505., , , , , , et al.
Jennifer M. Loftis Ph.D.* , Benjamin J. Morasco Ph.D. , Peter Hauser M.D.§, * Research and Development Service, Portland Veterans Affairs Medical Center, Portland, OR, Mental Health and Clinical Neurosciences Division, Portland Veterans Affairs Medical Center, Portland, OR, Department of Psychiatry, Oregon Health and Science University, Portland, OR, § Long Beach Veterans Affairs Medical Center, Long Beach, CA.