Department of Infectology, University Clinical Hospital Mostar, Kralja Tomislava 99, 88000 Mostar, Bosnia and Herzegovina,
Psychiatr Danub. 2020 Nov;32(Suppl 4):540-546.
Chronic hepatitis C was until recently treated with a combined therapy of interferon and ribavirin. More recently, direct antiviral agents (DAA), are being introduced. They are more tolerable and have fewer side effects, with better treatment results. In the Federation of Bosnia and Herzegovina we have started using this new therapy, with a limited financial opportunity. Large numbers of patients with chronic hepatitis C are former or current addicts, some of them treat their addiction with methadone or buprenorphine. These patients often formerly have a depression disorder and during treatment of chronic hepatitis need supervision of a psychiatrist, due to one of the side effects of interferon being deterioration of depression. Using this research we wanted to valorize the depression disorder of our patients, to indicate the effects of interferon on depression deterioration and the need for a new therapy protocol.
Examinees were patients with chronic hepatitis C on interferon therapy, which we divided into three groups: those who were never addicts, then the group of patients who were earlier addicts and have a long abstinence and patients who treat their addiction with a replacement therapy of methadone or buprenorphine. All patients completed Beck's test, which determines the level of depression, before and after interferon therapy.
Patients who used to be addicts or were on replacement therapy had mild or moderate depression before interferon treatment in a large number. After interferon therapy, there was a statistically substantial increase of patients with serious depression, which was not noted before the therapy.
Interferon therapy deteriorates depression in patients with chronic hepatitis C and there should be a strive for new therapies with less side effects in treatment. No patients stopped therapy. That is a result of community work and supervision over patients from both hepatologists and psychiatrists.
慢性丙型肝炎的治疗方法直到最近一直是干扰素和利巴韦林联合治疗。最近，直接抗病毒药物（DAA）已被引入。它们更耐受，副作用更少，治疗效果更好。在波斯尼亚和黑塞哥维那联邦，我们已经开始使用这种新的治疗方法，但资金有限。大量慢性丙型肝炎患者曾经或现在是吸毒者，其中一些人使用美沙酮或丁丙诺啡治疗毒瘾。这些患者通常以前患有抑郁症，由于干扰素的副作用之一是抑郁症恶化，因此在治疗慢性丙型肝炎期间需要精神病医生的监督。使用这项研究，我们旨在重视患者的抑郁障碍，表明干扰素对抑郁恶化的影响以及需要新的治疗方案。
受检者为接受干扰素治疗的慢性丙型肝炎患者，我们将其分为三组：从未吸毒者，以前吸毒且已长期戒毒者，以及使用美沙酮或丁丙诺啡替代疗法治疗毒瘾的患者。所有患者在接受干扰素治疗前后均完成贝克测试，以确定抑郁程度。
大量曾经吸毒或接受替代疗法的患者在接受干扰素治疗前存在轻度或中度抑郁。在干扰素治疗后，有统计学意义的大量患者出现严重抑郁，这在治疗前未被注意到。
干扰素治疗可使慢性丙型肝炎患者的抑郁恶化，因此在治疗中应努力寻找副作用较小的新疗法。没有患者停止治疗。这是肝病专家和精神病医生共同对患者进行社区工作和监督的结果。
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