Prophylactic Citalopram Treatment in Hepatitis C Patients on Antiviral Therapy: Will It Limit Drug-induced Depression and Enhance Adherence?
Patients were recruited from two Veterans Affairs hospitals. They were randomly assigned to a citalopram arm or a placebo arm. Patients who were already depressed, taking antidepressants, had abused substances within 6 months of the study, or had medical comorbidities that could interfere with treatment were excluded. Citalopram or placebo was begun 2 weeks after antiviral therapy was initiated. Patients were continued on the IFN-α and ribavirin for at least 24 to 48 weeks, depending on their genotype. Assessment of diagnosis was by the Structured Clinical Interview for the DSM-IV (SCID) 2 weeks before the antiviral treatment was administered. Both the Montgomery-Asberg Depression Rating Scale and the Beck Depression Inventory-II were administered throughout the study, which included eight follow-up visits during the first 24 weeks. The Hamilton Anxiety Depression Scale and two scales for adverse events were also used for neurotoxicity as well as the side effects of selective serotonin reuptake inhibitors (SSRIs). The final study cohorts included 19 on citalopram and 20 on placebo. Following the initial citalopram dose of 20 μm, increases after 2 weeks were allowed, up to a maximum of 60 μm daily, depending on the depression rating scale results.