Depressive symptoms and viral clearance in patients receiving interferon-α and ribavirin for hepatitis C

Charles L. Raison, Sherry D. Broadwell, Andrey S. Borisov, Amita K. Manatunga, Lucile Capuron, Bobbi J. Woolwine, Ira M. Jacobson, Charles Nemeroff, Andrew H. Miller

Research output: Contribution to journalArticle

118 Citations (Scopus)

Abstract

Interferon (IFN)-α plus ribavirin is an effective treatment for hepatitis C virus (HCV) infection, but is associated with a high rate of depression. Depression has been linked to a worse outcome in multiple medical disorders including viral illnesses. We examined whether increased symptoms of depression during IFN-α/ribavirin therapy were associated with a reduced treatment response as assessed by clearance of HCV. Depressive symptoms were evaluated in 102 HCV-infected patients at baseline and after 4, 8, 12, and 24 weeks of pegylated IFN-α-2b plus ribavirin therapy using the Zung self-rating depression scale (SDS). Viral clearance was determined at 24 weeks by polymerase chain reaction (PCR). Only 34% of subjects (10 out of 29) with a 20-point or greater increase in SDS Index score were HCV PCR negative at 24 weeks, compared to 59% (24 out of 41) of patients with a 10-19 point increase in SDS Index and 69% (22 out of 32) of patients with a less than 10 point increase (χ2=7.6, df=2, p<0.05). In addition, a 20-point or greater increase in SDS Index score during IFN-α/ribavirin therapy significantly predicted failure to clear virus when considered alone [crude odds ratio (OR), 3.2; 95% confidence interval (CI), 1.3-8.0; p<0.01] or when controlling for other factors that affected IFN-α treatment response (adjusted OR, 3.6; 95% CI, 1.3-9.5; p=0.01). These preliminary findings suggest that individuals who experience significant increases in depressive symptoms during IFN-α/ribavirin therapy may be less likely to clear virus, highlighting the importance of identifying and treating depressive symptoms in this patient population.

Original languageEnglish
Pages (from-to)23-27
Number of pages5
JournalBrain, Behavior, and Immunity
Volume19
Issue number1
DOIs
StatePublished - Jan 1 2005
Externally publishedYes

Fingerprint

Ribavirin
Hepatitis C
Interferons
Depression
Hepacivirus
Therapeutics
Odds Ratio
Confidence Intervals
Viruses
Polymerase Chain Reaction
Virus Diseases

Keywords

  • Cytokines
  • Depression
  • Gastroenterology
  • Hepatitis C
  • Interferon-α
  • Mood disorders
  • Ribavirin
  • Viral genotype
  • Viral load

ASJC Scopus subject areas

  • Immunology
  • Behavioral Neuroscience
  • Endocrine and Autonomic Systems

Cite this

Raison, C. L., Broadwell, S. D., Borisov, A. S., Manatunga, A. K., Capuron, L., Woolwine, B. J., ... Miller, A. H. (2005). Depressive symptoms and viral clearance in patients receiving interferon-α and ribavirin for hepatitis C. Brain, Behavior, and Immunity, 19(1), 23-27. https://doi.org/10.1016/j.bbi.2004.05.001

Depressive symptoms and viral clearance in patients receiving interferon-α and ribavirin for hepatitis C. / Raison, Charles L.; Broadwell, Sherry D.; Borisov, Andrey S.; Manatunga, Amita K.; Capuron, Lucile; Woolwine, Bobbi J.; Jacobson, Ira M.; Nemeroff, Charles; Miller, Andrew H.

In: Brain, Behavior, and Immunity, Vol. 19, No. 1, 01.01.2005, p. 23-27.

Research output: Contribution to journalArticle

Raison, CL, Broadwell, SD, Borisov, AS, Manatunga, AK, Capuron, L, Woolwine, BJ, Jacobson, IM, Nemeroff, C & Miller, AH 2005, 'Depressive symptoms and viral clearance in patients receiving interferon-α and ribavirin for hepatitis C', Brain, Behavior, and Immunity, vol. 19, no. 1, pp. 23-27. https://doi.org/10.1016/j.bbi.2004.05.001
Raison, Charles L. ; Broadwell, Sherry D. ; Borisov, Andrey S. ; Manatunga, Amita K. ; Capuron, Lucile ; Woolwine, Bobbi J. ; Jacobson, Ira M. ; Nemeroff, Charles ; Miller, Andrew H. / Depressive symptoms and viral clearance in patients receiving interferon-α and ribavirin for hepatitis C. In: Brain, Behavior, and Immunity. 2005 ; Vol. 19, No. 1. pp. 23-27.
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abstract = "Interferon (IFN)-α plus ribavirin is an effective treatment for hepatitis C virus (HCV) infection, but is associated with a high rate of depression. Depression has been linked to a worse outcome in multiple medical disorders including viral illnesses. We examined whether increased symptoms of depression during IFN-α/ribavirin therapy were associated with a reduced treatment response as assessed by clearance of HCV. Depressive symptoms were evaluated in 102 HCV-infected patients at baseline and after 4, 8, 12, and 24 weeks of pegylated IFN-α-2b plus ribavirin therapy using the Zung self-rating depression scale (SDS). Viral clearance was determined at 24 weeks by polymerase chain reaction (PCR). Only 34{\%} of subjects (10 out of 29) with a 20-point or greater increase in SDS Index score were HCV PCR negative at 24 weeks, compared to 59{\%} (24 out of 41) of patients with a 10-19 point increase in SDS Index and 69{\%} (22 out of 32) of patients with a less than 10 point increase (χ2=7.6, df=2, p<0.05). In addition, a 20-point or greater increase in SDS Index score during IFN-α/ribavirin therapy significantly predicted failure to clear virus when considered alone [crude odds ratio (OR), 3.2; 95{\%} confidence interval (CI), 1.3-8.0; p<0.01] or when controlling for other factors that affected IFN-α treatment response (adjusted OR, 3.6; 95{\%} CI, 1.3-9.5; p=0.01). These preliminary findings suggest that individuals who experience significant increases in depressive symptoms during IFN-α/ribavirin therapy may be less likely to clear virus, highlighting the importance of identifying and treating depressive symptoms in this patient population.",
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