Content area
Full Text
On the surface, it might appear that there is little mystery surrounding the well-established association between hepatitis C virus and depression. Like most chronic disease states, hepatitis C virus can lead to anxiety, fatigue and restlessness, conditions that can then manifest as depressive disorder. Additionally, patients with hepatitis C have significant neuropsychiatric co-morbidities, including depression. Furthermore, interferon, which has been used for treatment of HCV, is notorious for causing a spectrum of neuropsychiatric adverse effects. A generation of patients with HCV dealt with depressive symptoms largely due to interferon-based therapies. The introduction of ribavirin brought improved outcomes, but past and current research indicate that ribavirin may also contribute to depressive symptoms.
In the current generation of direct-acting antiviral agents, a new wave of data is showing that, apart from remarkably high 12-week sustained virological response rates, novel treatments are demonstrating effectiveness in reducing depression and depressive symptoms in HCV. However, whether they will prove to be a cure for depression remains to be seen. The clinical community is attempting to untangle the physiological and treatment-related effects of HCV on the neurocognitive system in the DAA era.
"There are different mechanisms that contribute to the onset of psychiatric disorders in people affected by HCV, regardless of therapy with [interferon]," Emanuela Apicella, MD, specialist in psychiatry at Villa Miralago, Health Center for Eating Disorder, Varese, Italy, told HCV Next. "The etiology of psychiatric disorders is multifactorial and several factors can lead to the development of the manifestations: genetic factors, evolutionary factors, environmental factors and life events."
Zobair M. Younossi, MD, MPH, chairman of the department of medicine at Inova Fairfax Hospital and vice president for research at Inova Health System in Falls Church, Va., is confident that adverse effects related to depression will likely not be seen in novel DAA regimens that are free from interferon and ribavirin. Another important issue related to HCV is the extrahepatic manifestation of HCV, which include fatigue and possibly depression. "Extrahepatic manifestationinduced issues may get better when we clear the virus," he said.
However, this does not mean that experts have solved all of the problems surrounding HCV and depression. "Chronic HCV infection itself causes a surge in inflammatory cytokines. These cytokines can affect the brain inducing neuropsychiatric manifestations," Younossi...