Trend of depression and the use of psychiatric medications in US Veterans with hepatitis C during interferon-based therapy

Objectives: Interferon-based therapy in patients with HCV infection may cause new psychiatric symptoms or worsening of existing psychiatric conditions. The aim of this study was to evaluate the trend of depression, and the use and the effect of psychiatric medications during interferon therapy. Methods: Patients with HCV were evaluated at our clinic following a standardized template to collect clinical and psychiatric data at baseline, weeks 2, 4, 8, 12, and every 6 wk thereafter. Depression was measured at each visit by obtaining the CES-D (Center for Epidemiologic Studies-Depression) score. A PMI was defined as the addition or increase in the dose of a psychiatric medication. Results: During interferon therapy, patients with psychiatric history (N = 46) had minor fluctuation in the CES-D score compared to baseline, while patients without psychiatric history (N = 33) had significant increase in their CES-D score, were more likely to require PMIs with antidepressants (63.6% vs 39.1%, respectively; P = 0.04), and they required the first PMI with sedatives/hypnotics earlier (4.1 wk vs 8.9 wk after starting interferon, respectively; P = 0.01). PMIs in the two groups resulted in significant decrease in CES-D score at 4-6 wk and 8-12 wk post-PMIs, but it continued to be higher than baseline. The overall sustained viral response was 47%. Conclusion: Hepatitis C patients with stable psychiatric history can be successfully treated with interferon-based therapy if followed closely by a multidisciplinary team that includes specialists in hepatitis C and behavioral health.