Evidence Based Treatment Approaches

Current treatments for hepatitis C include ribavirin and pegylated interferon alpha. The use of interferon alpha is complicated by numerous well-known side effects, including early flulike symptoms, elevated triglycerides, gastrointestinal symptoms, dermato-logical disorders, and neuropsychiatric symptoms that include depressed mood, poor concentration, loss of appetite, fatigue, hostility, and suicidal ideation (Dieperink et al. 2000). Depression has been reported to develop in as many as 39%-45% of patients receiving interferon alpha (Capuron et al. 2003; Lotrich et al. 2007). Pegylated interferon, when compared with conventional interferon, does not protect against depression (Lotrich et al. 2007). The use of interferon alpha has also been associated with completed suicide (Fukunishi et al. 1998; Jans-sen et al. 1994). The risk of depression and suicidal ideation may continue after withdrawal from interferon alpha. Patients with hepatitis C should be monitored routinely for depressive symptoms and suicidal ideation during and after treatment with interferon alpha. Work with adults supports the use of prophylactic or symptomatic antidepressant treatment for hepatitis C patients, typically using SSRI

medications such as citalopram (Kraus et al. 2008) or paroxetine (Raison et al. 2007), but additional research is necessary, and pediatric studies are lacking.

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