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Norepinephrine-enhancing antidepressant exposure associated with reduced antiviral effect of interferon alpha on hepatitis C

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Abstract

Rationale

Major depressive disorder is a common consequence of exposure to the pro-inflammatory cytokine interferon alpha, which is treated effectively with antidepressant medication. Antidepressant mode of action may conflict with interferon alpha’s mechanism in treating hepatitis C however.

Objectives

The purpose of this study is to prospectively explore, in a large naturalistic cohort, whether antidepressant exposure influenced end of treatment response of hepatitis C to interferon alpha.

Methods

Two hundred thirty-nine patients infected with chronic hepatitis C and due to receive treatment were recruited. All participants initiated peg-interferon-2-alpha 180 μg weekly sub-cutaneously plus oral ribavirin 800–1200 mg daily. Participants were assessed for DSM-IV major depression at baseline and four weekly during treatment.

Results

32.6 % of the cohort was exposed to an antidepressant (serotonin-reuptake inhibitor: other categorised antidepressants 49:29). At baseline, 3.8 % had major depression and 55.2 % developed major depression during interferon alpha treatment. Exposure to an antidepressant not classified as a serotonin-reuptake inhibitor, of which all were norepinephrine-enhancing (OR 0.15, 95 % CI 0.04–0.60) and having a past history of psychiatric disorder (OR 4.41, 95 % CI 1.39–13.96) independently reduced the likelihood of end of treatment response. Serotonin-reuptake inhibitor exposure did not influence end of treatment response (OR 1.21, 95 % CI 0.35–4.19), neither did major depression at baseline (OR 2.31, 95 % CI 0.55–9.60) or during treatment (OR 0.69, 95 % CI 0.36–1.33).

Conclusions

Our findings support a lack of conflict of therapeutic mechanism of serotonin-reuptake inhibitor antidepressants with interferon alpha in treating hepatitis C, which may include inflammatory influence. This appears not to be true for norepinephrine-enhancing antidepressant types and warrants investigation using more direct methods.

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Conflict of interest

RF was supported by an unrestricted financial grant for 1 year by Roche. JT received educational conference registration and travel support from Roche.

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Authors and Affiliations

  1. Sussex Partnership NHS Foundation Trust, Brighton, UK

    Renata Fialho & Richard Whale

  2. School of Psychology, University of Sussex, Brighton, UK

    Renata Fialho

  3. Brighton and Sussex Medical School, Falmer, Brighton, Sussex, BN1 9PH, UK

    Alison Burridge & Richard Whale

  4. Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal

    Marco Pereira

  5. Digestive Diseases Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK

    Majella Keller, Alexandra File & Jeremy Tibble

Authors
  1. Renata Fialho
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  2. Alison Burridge
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  3. Marco Pereira
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  4. Majella Keller
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  5. Alexandra File
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  6. Jeremy Tibble
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  7. Richard Whale
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Corresponding author

Correspondence to Richard Whale.

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Fialho, R., Burridge, A., Pereira, M. et al. Norepinephrine-enhancing antidepressant exposure associated with reduced antiviral effect of interferon alpha on hepatitis C. Psychopharmacology 233, 1689–1694 (2016). https://doi.org/10.1007/s00213-015-3956-4

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  • DOI: https://doi.org/10.1007/s00213-015-3956-4

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