Hepatitis C infection, antiviral treatment and mental health: A European expert consensus statement

Review article: depression and the use of antidepressants in patients with chronic liver disease or liver transplantation

“…Major depression has been reported in 15-49.5% of patients with chronic HCV infection, independent of the use of anti-viral treatment, [23][24][25][26] with a mean prevalence of 38% found in a review across 10 studies. 27 Of these patients, a significant proportion (up to 72%) had not been identified as having depression previously. 26 Multi-variate regression analysis of a large cohort of patients with chronic liver disease of different aetiologies (HCV, hepatitis B (HBV), alcohol-related liver disease and non-alcoholic fatty liver disease (NAFLD), both cirrhotic and noncirrhotic), who were screened for depression using the Patient Health Questionnaire-9 (PHQ-9) questionnaire, identified HCV only as an independent risk factor for depression.…”

“…through dopamine and serotonin transporter binding. 27 Anti-viral treatment of hepatitis C with interferon-alpha (IFN-a) also has a well-established role as a contributory factor to depression. Mild to moderate depression has been reported to develop in 45-60% of HCV patients treated with IFN-a, moderate to severe depression in 15-40%, and major depression in 15-45%.…”

“…Mild to moderate depression has been reported to develop in 45-60% of HCV patients treated with IFN-a, moderate to severe depression in 15-40%, and major depression in 15-45%. 27,[32][33][34][35] The type of interferon used (pegylated or standard interferon) does not appear to have any differential impact on the prevalence of IFN-a-related depression; however, it does appear to be sensitive to dosage and duration of treatment as well as pre-morbid patient-related risk factors, including a previous history of psychiatric disorders and female sex. 33,36 This phenomenon has an increasingly well-characterised biological basis, with activation of a pro-inflammatory cytokine network and alterations in serotonin and dopamine neurotransmitter metabolism being postulated to exert the mood changes associated with IFN-a.…”

“…33,36 This phenomenon has an increasingly well-characterised biological basis, with activation of a pro-inflammatory cytokine network and alterations in serotonin and dopamine neurotransmitter metabolism being postulated to exert the mood changes associated with IFN-a. 27,33 Specifically, IFN-a induces expression of indoleamine (2,3)-dioxygenase (IDO), which causes increased catabolism of the serotonin precursor, tryptophan, resulting in reduced peripheral serotonin levels. 37 The potential role of newer treatments (including direct-acting anti-virals and newer forms of interferon) in the treatment of chronic HCV is still being evaluated, but the data currently available for interferon-lamba 1 suggest there may be fewer neuropsychiatric complications resulting from its use compared to IFN-a.…”

Serotonin-norepinephrine reuptake inhibitor desvenlafaxine for the treatment of interferon alfa-associated depression in patients with hepatitis C

“…3 However, nonresponse or poor response is common. 4 Antidepressants with broader mechanisms of action, such as the serotonin and norepinephrine reuptake inhibitors (SNRI), could theoretically increase remission rates. One such agent, desvenlafaxine, presents a favorable pharmacokinetic profile and its hepatic metabolism consists essentially of glucuronidation.…”