These are older data; since 1992, we've been able to screen blood products.
.What Happened to Those Treated With Interferon?
Of the patients who were treated (83 out of 300) over half of them had no response but a significant proportion, 18%, had to stop due to side effects, depression being among the most common side effects.The overall results were very dismal. Only 3% had a sustained response. The vast majority was really untreated What is the association of depression and hepatitis C? The answer is there probably is no direct association.
Is there an association of depression and interferon therapy? I think, unequivocally, we can say yes, at least some symptoms of depression; a significant proportion of patients have moderate to severe depression.
Can antidepressants be given safely to patients with hepatitis C? The answer to this is yes.
Can antidepressants reverse interferon-induced depression? The response rates are rather robust and it can be successfully treated, allowing patients to stay on interferon therapy.
Should antidepressants be used prophylactically? The answer to this question is, "Not yet." I think we have to conduct studies first before we have a blanket policy of treating all patients prophylactically.
In regard to the association of depression and hepatitis C diagnosis, there's probably no association. There are higher rates of depression in older age patients, in patients with a hepatitis C diagnosis in which the patient has known about their diagnosis for 5 of more years, and in those patients who have been told they're not treatment candidates.
Patients with a substance abuse diagnosis probably have higher rates of depression than those patients with a substance abuse diagnosis who don't have hepatitis C, although I think in both groups depression is quite high. Recently diagnosed patients are less likely to be depressed. The group at highest risk for depression and suicide are those who have known about the diagnosis for some time.Is interferon therapy associated with depression? This is a summary of some larger sample size studies, from 80 to hundreds of patients, and the rates of depression vary from 3% to 44%. The reason for this discrepancy is how carefully depression was assessed. In the studies that use a rating instrument, they're much more likely to detect depression than in those studies that wait for a patient who is often fatigued, anhedonic, and psychomotor retarded to tell you about their depression.
Studies of IFN-Induced Depression and HCV
Here are some of the sample sizes of studies of interferon-induced depression. There is a case series of 5 patients. In our study we carefully studied 39 patients, and only 11 were treated; only 11 developed depression.
It is remarkable that in such a common side effect, depression, happening in 1 in 5 to 1 in 3 patients, that we have very few studies that have addressed this particular symptom. I think it's important that we begin to have larger sample size studies so we have some evidence-base with which we can make informed decisions with our patients about treatment.
There is another case series on sertraline of 10 patients
