Depression Comorbidity and Antidepressant Use in Veterans With Chronic Hepatitis C: Results From a Retrospective Chart Review
J Clin Psychiatry 2008;69(5):810-816
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: The 2002 National Institutes of Health Consensus
Conference Statement recommended that both clinical and research efforts be
made to increase the availability of hepatitis C virus (HCV) treatment to
patients who were previously ineligible because of comorbid psychiatric illness
and substance use disorders. However, little research on patients with HCV and
comorbid depression has been conducted that can serve to inform and guide
treatment of HCV. In this study we characterize the prevalence and severity of
comorbid depression, as well as antidepressant and other psychotropic
prescribing patterns, in a sample of U.S. veterans with HCV.
Method: Participants were recruited between November 2002 and
July 2005 from the liver specialty clinic and from a 1-time HCV patient
education class conducted through the Portland Department of Veterans Affairs
Northwest Hepatitis C Resource Center. Patients who signed informed consent
were asked to complete the Beck Depression Inventory, Second Edition (BDI-II),
and their medical records were reviewed for information regarding active
prescriptions for psychotropic medications and prior psychiatric diagnoses.
Results: Of the 881 veterans enrolled in the study, 783 (89%)
completed the BDI-II. Approximately one third (34%, 264/783) of the veterans
endorsed moderate to severe symptoms of depression (BDI-II score >= 20), and
37% (290/783) were prescribed an antidepressant; however, 48% (140/290) of
veterans prescribed an antidepressant continued to endorse moderate to severe
depressive symptoms. Furthermore, of all veterans endorsing moderate to severe
symptoms of depression (N = 264), only about half (56%, 148/264) were
prescribed an antidepressant.
Conclusion: On the basis of BDI-II scores, a significant
proportion of veterans with HCV experience moderate to severe depressive
symptoms. Although antidepressants were the most commonly prescribed
psychotropic medication, many who were prescribed an antidepressant continued
to experience high levels of depressive symptoms, an important consideration
when deciding whether to initiate antiviral therapy to treat HCV.