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Impact of depression and antidepressant use on clinical outcomes of hepatitis B and C: a population-based study

Abdel Aziz Shaheen1,2, Gilaad G Kaplan1,2, Keith A Sharkey2,3,4

  • 1Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

Hepatology Communications
|February 15, 2023
PubMed

Insights

Major depressive disorder (MDD) did not impact survival in patients with hepatitis B (HBV) or C (HCV). However, tricyclic and tetracyclic antidepressants (TCAs) were linked to poorer survival outcomes in these viral hepatitis patient groups.

Area of Science:

  • Hepatology
  • Psychiatry
  • Clinical Epidemiology

Background:

  • Depression is a common comorbidity in patients with chronic viral hepatitis B (HBV) and hepatitis C (HCV).
  • The impact of major depressive disorder (MDD) and antidepressant use on outcomes in these patient populations requires further investigation.

Purpose of the Study:

  • To evaluate the association between major depressive disorder (MDD) and antidepressant use with survival in patients diagnosed with HBV and HCV.
  • To determine if MDD or specific antidepressant classes influence the risk of decompensated cirrhosis or mortality in viral hepatitis patients.

Main Methods:

  • Utilized The Health Improvement Network (THIN) database, a large UK medical database, to identify incident HBV (n=1401) and HCV (n=1635) cases between 1986 and 2017.
  • Assessed MDD and antidepressant use (including TCAs and SSRIs) using multivariate Cox proportional hazards models, adjusting for clinical comorbidities, age, and sex.
  • Primary composite outcome included the development of decompensated cirrhosis or death.

Main Results:

  • MDD prevalence was significantly higher in HCV patients (23.5%) compared to HBV patients (9.0%).
  • Antidepressant use was also more frequent in HCV patients (59.6%) versus HBV patients (27.1%).
  • MDD was not an independent predictor of survival or decompensated cirrhosis. However, tricyclic and tetracyclic antidepressant (TCA) use was associated with poorer decompensated cirrhosis-free survival in both HBV and HCV cohorts. TCAs in HBV and selective serotonin reuptake inhibitors (SSRIs) in HCV were linked to poorer overall survival.

Conclusions:

  • Despite its prevalence, MDD did not significantly affect disease progression or survival in HBV or HCV patients.
  • Tricyclic and tetracyclic antidepressant (TCA) use was associated with adverse survival outcomes, specifically reduced decompensated cirrhosis-free survival.
  • Further research is warranted to investigate the impact of TCA use on outcomes in patients with viral hepatitis.
Abstract

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