Depression in chronic hepatitis C patients and the role of cognitive behavioral therapy in its treatment

Abstract

Background Hepatitis C is a major health problem in Egypt and worldwide. Hepatitis C is associated with an increased prevalence of psychiatric disorders, particularly depression. In addition, depression is one of the neuropsychiatric side effects of interferon (IFN) therapy. Although antidepressants have been proven to be effective in the treatment of depression in this patient population, the risk of hepatotoxicity and toxicity warrants the search for other treatment alternatives for depression, such as cognitive behavioral therapy (CBT). Patients and methods A sample of 100 hepatitis C-seropositive patients was divided into two groups: 50 IFN-treated patients and 50 patients not undergoing IFN treatment. All the patients were subjected to an assessment of detailed history and a physical examination and were evaluated for the presence of depression using the Structured Clinical Interview for DSM-IV axis I disorder (SCID-I), the Hamilton Rating Scale for Depression (HAM-D), and the Zagazig Depression Scale (ZDS). The patients who were diagnosed with depression received a course of CBT, and were tested using the same scales after completing the CBT and after 3 months of completing the therapy. Results Our data confirm the high rate of major depressive disorders among the population of patients with hepatitis C, with the prevalence of depression being higher in the group undergoing treatment with IFN (40%) than the untreated group (28%). Depression scores on both HAM-D and ZDS were higher in the IFN-receiving group. CBT intervention resulted in a marked decrease in ZDS and HAM-D scores over time in both the groups. Conclusion We concluded that a huge percentage of chronic hepatitis C patients develop depression, both those who undergo IFN treatment and those who did not receive any HCV treatment. CBT has been found to be an efficacious treatment for this adverse effect.