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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

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.