Dr. Marina Klein
CTN National Co-Director; Member, Steering Committee
McGill UniversityView Bio
The objective of this study was to evaluate the use of citalopram, an antidepressant, before starting and during hepatitis C (HCV) treatment to prevent the development of depression. This study included people co-infected with HIV and hepatitis C who were about to start treatment for hepatitis C. Participants were randomized to receive either citalopram or a placebo. Three weeks after starting citalopram (or placebo) participants received pegylated interferon and ribavirin (Pegetron®) for 24 to 48 weeks, depending on their HCV genotype. The study compared participants’ adherence to HCV treatment and symptoms of depression between the participants receiving citalopram and the participants receiving placebo.
Hepatitis C is a liver disease caused by the hepatitis C virus (HCV). Infection with HCV is common among people living with HIV due to similar routes of transmission. HCV is spread mostly through contact with the blood or blood products of an infected person. It is estimated that at least 75 percent of people exposed to HCV become chronically infected, meaning that their bodies are unable to control the virus. HCV can be treated with pegylated interferon but these medications may cause depression in some patients. This results in very low rates of HCV treatment initiation and completion in co-infected individuals.
A total of 76 participants were enrolled between November 2006 and April 2011: 36 were randomized to citalopram and 40 to placebo.
Adherence to treatment was high in both the anti-depressant and placebo groups in a multi-disciplinary care setting, suggesting that effective treatment is possible, even in high-risk populations. The use of citalopram during HCV treatment did not result in higher adherence, reduction in treatment-limiting depression, or depressive symptoms in the study participants. The study team concluded that because there are no clear benefits to taking an antidepressant without depression, alternative strategies such as early diagnosis and treatment of depression should be developed.