To the Editor:
Within the context of published literature on interferon (IFN)-induced depression and HCV, Leutscher et al. highlight the complex relationships among mood, IFN, antidepressants, and sustained viral response (SVR) (1). Consistent with previous studies, Leutscher et al. found that ~30% of patients receiving IFN-based therapy developed major depressive disorder (MDD). They also reported that IFN-induced depression was associated with a reduced likelihood of obtaining an SVR and stated that their study was the first to report this relationship (1). However, research has addressed this controversial topic (2–6). A prospective study (n = 394) analyzed the relationship between baseline and new-onset depression and treatment outcomes, and SVR rates did not differ between patients who developed MDD and those who did not (6). Results from our retrospective cohort study support and extend these findings by comparing rates of antiviral therapy completion and SVR between patients with HCV and MDD versus those without MDD (7). We found that the MDD group had completion and SVR rates similar to patients without MDD. In our study, all patients with MDD were on antidepressant medications prior to and during antiviral therapy.
Untreated IFN-induced depression may lead to dose reductions, premature IFN therapy termination, and compromised treatment outcomes. Leutscher et al. reported that almost half of the patients with MDD did not receive psychotropic medication and that their study was insufficiently powered to evaluate whether antidepressants affected viral clearance (1). Prior literature shows that careful monitoring of neuropsychiatric symptoms during antiviral therapy and initiation of antidepressants if significant symptoms of depression develop can be an effective strategy for optimizing treatment outcomes in patients with HCV.
Acknowledgments
Financial support: Dr. Loftis’ research is supported by a Career Development Award from the Veterans Health Administration and by grant support from the National Institute on Drug Abuse (NIDA). Dr. Morasco receives support from award K23DA023467 from NIDA. Dr. Hauser receives grant support from the VA Research Merit Review Program, Veterans Health Administration.
List of abbreviations
- HCV
hepatitis C viral infection
- IFN
interferon
- MDD
major depressive disorder
- SSRI
selective serotonin re-uptake inhibitor
- SVR
sustained viral response
Contributor Information
Jennifer M. Loftis, Email: loftisj@ohsu.edu, Jennifer.loftis2@va.gov.
Benjamin J. Morasco, Email: Benjamin.morasco@va.gov.
Peter Hauser, Email: Peter.hauser2@va.gov.
References
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