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Stabilized depression no barrier to hepatitis C tx. (Antiviral Agents and Depressive Symptoms).

BETHESDA, MD. -- Hepatitis C patients who have stabilized depression can now be considered eligible for combination antiviral therapy to treat the liver disease, according to participants in a consensus development conference on hepatitis C sponsored by the National Institutes of Health.

Until now, antiviral agents were contraindicated in patients with stabilized depression because the drugs are known to induce depressive symptoms in 20%-30% of patients.

But experts now contend that despite this risk, "the best current treatment" for hepatitis C--namely ribavirin combined with pegylared, rather than standard, interferon--should be made available to everyone with the disease, including those with depression.

"All patients with chronic hepatitis C are potential candidates for antiviral therapy," according to the statement from the consensus development conference.

The combined regimen has proved more effective at combating the hepatitis C virus than monotherapy, and the pegylated form of interferon appears to induce fewer adverse neuropsychiatric effects than standard interferon, consensus conference panelists said.

The exact mechanism by which antivirals, and interferon in particular, induce depression is unknown.

Patients with stabilized depression who take antiviral drugs for hepatitis C must be closely monitored.

They and their significant others should be questioned directly about the presence and severity of depressive symptoms, and antiviral treatment should be discontinued immediately if they develop suicidal ideation.

Antidepressants, particularly selective serotonin reuptake inhibitors, are often effective for the typically mild depression that accompanies antiviral therapy, according to panelists.

The use of prophylactic antidepressants is not recommended as yet, since the 70%-8O% of patients who will not develop depression would be treated unnecessarily.

However, prophylactic pamxetine was demonstrated to minimize depressive symptoms in a study of melanoma patients who received high-dose interferon for their cancers.

A closer look at prophylaxis in people with depression is warranted, according to the panelists at the consensus development conference.

The statement recommended that antiviral treatment now be offered not only to hepatitis C patients with depression, but also to a host of other groups who have been largely excluded from receiving it before. These other groups include the elderly, children, people coinfected with HIV, injection drug users, patients with decompensated cirrhosis, alcohol abusers, and incarcerated populations.

Most of the clinical trials that have been done to date have had such rigid exclusion criteria that none of these groups has been adequately evaluated.

Previous antiviral treatment recommendations therefore have been based on data "from a small minority of pristine patients," in the words of one conference participant.

Now there are some data on treating these patient groups. Although the data are only preliminary, they are sufficient to show that these patients often do respond to combination antiviral therapy.

"They may not respond as well [as the typical trial subject], but the panel strongly recommends that they be considered for the best current treatment, too," said Dr. James Boyer, panel chair and director of the liver center at Yale University, New Haven.
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Author:Moon, Mary Ann
Publication:Clinical Psychiatry News
Article Type:Brief Article
Geographic Code:1USA
Date:Aug 1, 2002
Words:484
Previous Article:Letters.
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