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Evaluation of depression as a risk factor for treatment failure in chronic hepatitis C.

Journal article
Authors Peter Derek Christian Leutscher
Martin Lagging
Mads Rauning Buhl
Court Pedersen
Gunnar Norkrans
Nina Langeland
Kristine Mørch
Martti Färkkilä
Simon Hjerrild
Kristoffer Hellstrand
Per Bech
Published in Hepatology
Volume 52
Issue 2
Pages 430-435
ISSN 1527-3350
Publication year 2010
Published at Institute of Biomedicine
Pages 430-435
Language en
Links dx.doi.org/10.1002/hep.23699
Keywords Adult, Antiviral Agents, therapeutic use, Depressive Disorder, Major, complications, etiology, Female, Hepatitis C, Chronic, complications, drug therapy, Humans, Interferon Alfa-2a, therapeutic use, Male, Polyethylene Glycols, therapeutic use, Ribavirin, therapeutic use, Risk Factors, Treatment Failure
Subject categories Microbiology in the medical area

Abstract

The Major Depression Inventory (MDI) was used to estimate the value of routine medical interviews in diagnosing major depression among patients receiving peginterferon alfa-2a and ribavirin therapy for chronic hepatitis C virus (HCV) infection (n = 325). According to criteria from the MDI and Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), 19 patients (6%) had major depression at baseline. An additional 114 (37%) developed depression while on HCV combination therapy, with baseline MDI score and female sex independently predicting the emergence of major depression during treatment in a multivariate analysis. Only 36 (32%) of the 114 patients developing major depression according to MDI/DSM-IV criteria were correctly diagnosed during routine medical interviews. The emergence of major depression frequently led to premature discontinuation of peginterferon/ribavirin therapy, and an on-treatment MDI score increment exceeding 30 points (i.e., a validated marker of idiopathic DSM-IV major depression) was correlated with impaired outcome of HCV therapy (P = 0.02). This difference was even more pronounced among patients with an on-treatment increase in MDI score greater than 35 points (P = 0.003). Conclusion: We conclude that (1) depressive symptoms among patients undergoing HCV therapy are commonly overlooked by routine clinical interviews, (2) the emergence of depression compromises the outcome of HCV therapy, and (3) the MDI scale may be useful in identifying patients at risk for treatment-induced depression.

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