Patients with chronic HCV experienced fewer or reduced symptoms of depression when taking escitalopram simultaneously with antiviral therapy in a recent study.
In a multicenter, double blind, prospective trial, 181 patients with HCV randomly received 10 mg/day of escitalopram (n=90) or placebo (n=91) 2 weeks before and between 24 or 48 weeks during antiviral treatment with pegylated interferon-alfa with ribavirin (PEG-IFN). Both groups underwent follow-up equivalent in length to treatment duration, and underwent psychiatric assessments at 14, 8 and 2 weeks before therapy, as well as at weeks 2, 4, 12 and 24 of therapy and during follow-up. Depression was defined as a Montgomery-Asberg Depression Rating Scale (MADRS) score of 13 or greater. No participants had a history of psychiatric disease prior to the study.
In the escitalopram group, 32% of patients (95% CI, 21%-43%) experienced depression compared with 59% (95% CI, 48%-69%) of the placebo group (P<.001 for difference). Eight percent of the treated group and 19% of the placebo group were diagnosed with major depression (P=.031 for difference). MADRS scores were lower in the treated group than the placebo group at week 12 (mean difference 2.8, P=.004), week 24 (mean difference 3.1, P=.002) and week 48 (mean difference 5.2, P<.001). Multivariate analysis indicated that female sex (P=.027) and MADRS score at baseline (P<.001) were associated with depression related to treatment.
Tolerability and safety of treatment were not significantly different between the groups. Therapy was completed by 87% of the treated group and 88% of the placebo group, with five patients in each group discontinuing because of serious adverse events. Incidence of events was higher in the placebo group (87%) than the treated group (74%) (P=.022 for difference).
“Given the current and future treatment options for PEG-IFN-a in gastroenterology, dermatology and oncology and the burden of treatment-associated depression, our study’s findings are highly relevant for improving and optimizing the safety and tolerability of [interferon-alfa] treatment,” the researchers wrote.
Disclosure: See the study for a full list of relevant disclosures.