Clinical Data and Best Practices for Managing Depression in HCV-Infected Patients Treated With Peginterferon and Ribavirin
Source: Management of Depression and HCV: Novel Data, Best Practices, and Case Challenges - Click here to view
Posting Date: February 24, 2009
Abstract
Worldwide, 170 million people are estimated to be infected with HCV. Chronic HCV infection is the leading cause of chronic liver disease, including cirrhosis and HCC, and is the most common indication for liver transplantation. The prevalence of HCV in the general population of the United States and Western Europe ranges from 1.0% to 2.4%. The prevalence of HCV infection among patients with chronic psychiatric disorders has also been found to be significantly elevated—between 6.8% and 8.5%. Overall, the prevalence of depression among individuals infected with HCV is higher than that of the general population: rates have been estimated at 6% to 10% for the general population and 24% to 70% for HCV-infected individuals.
Interferon alfa remains the cornerstone of treatment for chronic hepatitis C and will remain an important component of treatment regimens for the foreseeable future, even when novel targeted therapies become available. Antiviral treatment with interferon, as well as chronic HCV infection itself, can be associated with several central nervous system changes, notably fatigue, anhedonia, depression, irritability, cognitive disturbances, psychotic symptoms, delirious syndromes, relapse in alcohol or drug abuse, or suicidal thoughts and attempts. Psychiatric adverse events may lead to dose reduction and treatment discontinuation affecting the efficacy of interferon-based therapy. In addition, the patient’s quality of life may be markedly reduced during treatment. Therefore, management of psychiatric events and cooperation with an experienced psychiatrist are crucial for treatment success.
This module by Martin Schaefer, MD describes the most current research and thinking on HCV- and interferon-related depressive mood changes as well as recommendations for their clinical management. In addition, special aspects of depression-related psychiatric problems, such as cognitive disturbances, sleep disturbances, and fatigue are examined. The module concludes with a review of current data regarding HCV treatment in patients at risk for psychiatric disorders and patients with preexisting psychiatric disorders and/or drug addictions.
