Term Paper: Hepatitis C Treatments: Their Link

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[. . .] In Fried and others (2001), patients treated with pegylated interferon had fewer instances of depression than those treated with non-pegylated interferon and ribavirin. (Fried et al., 2001). Few studies exist using anti-depressants to pre-treat depression for those with Hepatitis C This reflects an older opinion among clinicians that depression is just part of Hepatitis C treatment and one that patients had to accept. Recent developments suggest that depression may no longer need to be an accepted part of Hepatitis C treatments.

Research Question

Although this phenomenon is well documented, studies conducted on the subject have had several biases. Many of these studies were conducted in tertiary care facilities. Hepatitis C is highly prevalent among substance abusers. Many studies concerning depression associated with Interferon/Ribavirin treatment have been conducted among this population, which tends to have a higher incidence of depression as compared to the normal population. It cannot therefore be determined if the results are applicable to the general population, including persons with Hepatitis C who are not substance abusers. So the question still remains as to whether Rebetron causes depression in the general population or if it is limited those who are prone to depression disorders. Studies need to be conducted among Hepatitis C patients who are not in the category of substance abusers or already depressed before taking interferon.

Hypothesis

Studies concerning the incidence of depression among persons who have Hepatitis C and are being treated with interferon has been confined to those who already have a natural tendency to depression. This research will confirm that these results, not only apply to the groups previously found to have this tendency, but that they will apply to the general population of Hepatitis C patients as well, including those who are not substance abusers or who have no other factors pre-disposing them to depression.

Methodology

The sample population for this group will include eight persons who are members of a Hepatitis C Support group in Broward County Florida. These persons will be screened for conditions predisposing them to depression. The sample size is small and therefore will be similar to a case study.

The study will be conducted using a survey to determine if the persons are on Rebetron or Pegylated interferon therapy for hepatitis C it will determine if they have ever had depression in the past or have conditions that predispose them to depression, prior to receiving interferon treatment for Hepatitis C it will assess whether they are currently depressed, are being treated for depression, or have stopped taking interferon as a result of depression.

Data analysis will use standard statistical procedures to validate the data and determine correlation coefficients. It is expected that the small ample size will make the data contain sample bias and that it will only give preliminary data, which could be used to design a larger study with a larger sample size in the future. The data may contain a certain amount of bias, as all of these persons are in the same location and have been working together for some time. It is expected that the qualitative results of the survey will be of more value than the quantitative results due to the small sample size.

Findings

Due to the known effect of interferon on seratonin levels and the known effects of this chemical on mood, it can be expected that this study will reveal that approximately 25-30% of the patients on interferon will have or have had experienced depression as a result of the therapy. This will include those who have discontinued interferon therapy due to depression. These results would be consistent with previous studies conducted on the effects of interferon-induced depression.

Limitations

The primary limitation of this study, will be the ability to generalize the results to the general population of Hepatitis C patients on Rebetron or Pegylated interferon. The sample size is small and will not be easily applied to the general population. In addition, different results may be obtained in a more randomly selectes population, comprised of persons in various locations. It will also not be determined if all of the patients are on the same dosage of interferon or how long they have been being treated with interferon. These factors may influence the results. For this reason, this study the results will be treated as preliminary, in lieu of results obtained in more controlled settings such as a hospital from a sample pool of patients on known dosages of interferon. This type of controlled study is beyond the scope of this study due to laws prohibiting the release of medical information from medical facilities.

Implications

Interferon-induced depression has wide implications for those in the social work field. Due to the high rate of interferon-induced depression and the severity of some cases, it is important that a professional from the field of psychology be included in the treatment team of Hepatitis C patients. This professional will be important in determining pre-existing risk factors in the patient and in helping to offset any negative psychological effects from the treatment. Standard drug therapies have been used to prevent depression in patients undergoing interferon treatment. A social worker could be of help by providing group therapy and support for those on interferon therapy. A social worker in this case may be a valuable member of the team in assessing the severity of side effects and could be of assistance in preventing the side effects from becoming more severe or being hidden from the doctor. A group therapy program could be beneficial in providing information and support for those taking interferon and may be one of the most important tools for preventing suicide from interferon-induced therapy. This study will help to determine if these types of services would be helpful for these patients.

Interferon-induced depression is a known side effect of Hepatitis C treatments. It has along history of being either not treated at all or dismissed as a normal part of treatment. Depression can severely effect the quality of a patient's life and can sometimes be fatal. Patients at particular risk should be screened and monitored closely for sign of new or worsening depression. Treatment is available for these patients and they do not have to suffer needlessly. Often physicians tend to either mis-diagnose the signs of depression, or dismiss them in lieu of physical symptoms. They are trained to diagnose the body and often could obtain beneficial results for the patient by referring them to specialists in the field of psychology. It is the goal of every disease treatment to enhance the quality of life of the patient. Quality of life goes beyond physical symptoms and in order to maintain a better quality of life, it is necessary to attend to the patient's mental condition as well.

An interdisciplinary approach to medicine could be helpful, no only in the treatment of interferon-induced depression, but could be useful in the treatment of other diseases as well. A person's well-being is influenced by their attitudes and outlook on life. Maintaining a positive outlook on life could have a positive outcome on the medical side of the treatment and long-term prognosis of the patient. The benefits of including a psychological professional as part of the treatment team could have significant effects on their life. Medicine and psychology need to work more closely than they have in the past. The maximum benefit for the patient can only be obtained if this is done.

Works Cited

Adams, F, Quesada JR, Gutterman JU. (1984) Neuropsychiatric manifestations of human leukocyte interferon therapy in patients with cancer. Journal of the American Medical Association. Volume 252, pp. 938-941 [Medline Database].

Alter, MJ, Kruszon-Moran D, Nainan OV, McQuillan GM, Gao F, Moyer LA, Kaslow RA, et al. (1999) the prevalence of hepatitis C virus infection in the United States, 1988 through 1994. New England Journal of Medicine. Volume 341, pp. 556-562 [Medline Database].

Boutiler, Alan and Hosein, Sean. (2000) Combination therapy for hepatitis C 7th Conference on Retroviruses and Opportunistic Infections, January 30 to February 2, 2000, San Francisco - TreatmentUpdate. The Community AIDS Treatment Information Exchange (CATIE) CATIE News: February 4, 2000. Retrieved at http://www.CATF-N20000202.html. July 22, 2002.

Brown, RR, Ozaki Y, Datta SP, Borden EC, Sondel PM, Malone DG. (1991) Implications of interferon-induced tryptophan catabolism in cancer, autoimmune diseases and AIDS. Advanced Experimental Medical Biology Volume 294, pp.425-435 [Medline Database].

Capuron, L, Ravaud a. (1999) Prediction of the depressive effects of interferon alpha therapy by the patient s initial affective state. New England Journal of Medicine. Volume 340, p. 1370 [Medline Database].

Carpiniello, B, Orru MG, Baita a, Pariante CM, Farci G. (1998) Mania induced by withdrawal of treatment with interferon alfa. Archives of General Psychiatry Volume 55, pp. 88-89 [Medline Database].

Darko, Zdilar, Franco-Bronson, Kathleen, Buchler, Nancy, Locala, Joseph a. And Younossi, Zobair M. (2000) Hepatitis C, Interferon Alfa, and Depression. Hepatology, June 2000, Volume 31, No. 6, pp. 1207-1211, From the Departments of Psychiatry and Psychology and… [END OF PREVIEW]

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