Impact of depression and antidepressant use on clinical outcomes of hepatitis B and C: a population-based study
Background:. Depression is common in patients with chronic viral hepatitis. We evaluated the impact of major depressive disorder (MDD) and antidepressant use on survival among patients with HBV and HCV. Methods:. We used The Health Improvement Network database, the largest medical database in the UK...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Health/LWW
2023-03-01
|
| Series: | Hepatology Communications |
| Online Access: | http://journals.lww.com/10.1097/HC9.0000000000000062 |
| _version_ | 1811161598563188736 |
|---|---|
| author | Abdel Aziz Shaheen Gilaad G. Kaplan Keith A. Sharkey B. Cord Lethebe Mark G. Swain |
| author_facet | Abdel Aziz Shaheen Gilaad G. Kaplan Keith A. Sharkey B. Cord Lethebe Mark G. Swain |
| author_sort | Abdel Aziz Shaheen |
| collection | DOAJ |
| description | Background:. Depression is common in patients with chronic viral hepatitis. We evaluated the impact of major depressive disorder (MDD) and antidepressant use on survival among patients with HBV and HCV.
Methods:. We used The Health Improvement Network database, the largest medical database in the UK, to identify incident HBV (n=1401) and HCV (n=1635) in patients between 1986 and 2017. Our primary composite outcome was the development of decompensated cirrhosis or death. MDD and each class of antidepressants were assessed in multivariate Cox proportional hazards models. Models were adjusted for age, sex, and clinical comorbidities.
Results:. The prevalence of MDD among HCV patients was higher compared with HBV patients (23.5% vs. 9.0%, p<0.001, respectively). Similarly, HCV patients were more likely to use antidepressants (59.6%) compared with HBV patients (27.1%), p>0.001. MDD was not an independent predictor for decompensated cirrhosis-free survival or mortality. However, the use of tricyclic and tetracyclic antidepressants (TCAs) was associated with poor decompensated cirrhosis-free survival in HBV and HCV cohorts (adjusted HR: 1.80, 95% CI, 1.00–3.26 and 1.56, 95% CI, 1.13–2.14, respectively). Both TCAs in the HBV cohort and selective serotonin reuptake inhibitors among the HCV cohort were associated with poor overall survival (adjusted HR: 2.18, 95% CI, 1.16–4.10; 1.48, 95% CI, 1.02–2.16, respectively).
Conclusions:. Although prevalent among viral hepatitis patients, MDD did not affect disease progression or survival in either HBV or HCV cohorts. TCA use was associated with poor decompensated cirrhosis-free survival. Therefore, its use should be further studied among viral hepatitis patients. |
| first_indexed | 2024-04-10T06:16:56Z |
| format | Article |
| id | doaj.art-0ec8fd5352e24214bbf8bf3712e129fd |
| institution | Directory Open Access Journal |
| issn | 2471-254X |
| language | English |
| last_indexed | 2024-04-10T06:16:56Z |
| publishDate | 2023-03-01 |
| publisher | Wolters Kluwer Health/LWW |
| record_format | Article |
| series | Hepatology Communications |
| spelling | doaj.art-0ec8fd5352e24214bbf8bf3712e129fd2023-03-02T06:30:57ZengWolters Kluwer Health/LWWHepatology Communications2471-254X2023-03-0173e0062e006210.1097/HC9.0000000000000062HC90000000000000062Impact of depression and antidepressant use on clinical outcomes of hepatitis B and C: a population-based studyAbdel Aziz Shaheen0Gilaad G. Kaplan1Keith A. Sharkey2B. Cord Lethebe3Mark G. Swain4 1 Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada 1 Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada 2 Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada 1 Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada 1 Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, CanadaBackground:. Depression is common in patients with chronic viral hepatitis. We evaluated the impact of major depressive disorder (MDD) and antidepressant use on survival among patients with HBV and HCV. Methods:. We used The Health Improvement Network database, the largest medical database in the UK, to identify incident HBV (n=1401) and HCV (n=1635) in patients between 1986 and 2017. Our primary composite outcome was the development of decompensated cirrhosis or death. MDD and each class of antidepressants were assessed in multivariate Cox proportional hazards models. Models were adjusted for age, sex, and clinical comorbidities. Results:. The prevalence of MDD among HCV patients was higher compared with HBV patients (23.5% vs. 9.0%, p<0.001, respectively). Similarly, HCV patients were more likely to use antidepressants (59.6%) compared with HBV patients (27.1%), p>0.001. MDD was not an independent predictor for decompensated cirrhosis-free survival or mortality. However, the use of tricyclic and tetracyclic antidepressants (TCAs) was associated with poor decompensated cirrhosis-free survival in HBV and HCV cohorts (adjusted HR: 1.80, 95% CI, 1.00–3.26 and 1.56, 95% CI, 1.13–2.14, respectively). Both TCAs in the HBV cohort and selective serotonin reuptake inhibitors among the HCV cohort were associated with poor overall survival (adjusted HR: 2.18, 95% CI, 1.16–4.10; 1.48, 95% CI, 1.02–2.16, respectively). Conclusions:. Although prevalent among viral hepatitis patients, MDD did not affect disease progression or survival in either HBV or HCV cohorts. TCA use was associated with poor decompensated cirrhosis-free survival. Therefore, its use should be further studied among viral hepatitis patients.http://journals.lww.com/10.1097/HC9.0000000000000062 |
| spellingShingle | Abdel Aziz Shaheen Gilaad G. Kaplan Keith A. Sharkey B. Cord Lethebe Mark G. Swain Impact of depression and antidepressant use on clinical outcomes of hepatitis B and C: a population-based study Hepatology Communications |
| title | Impact of depression and antidepressant use on clinical outcomes of hepatitis B and C: a population-based study |
| title_full | Impact of depression and antidepressant use on clinical outcomes of hepatitis B and C: a population-based study |
| title_fullStr | Impact of depression and antidepressant use on clinical outcomes of hepatitis B and C: a population-based study |
| title_full_unstemmed | Impact of depression and antidepressant use on clinical outcomes of hepatitis B and C: a population-based study |
| title_short | Impact of depression and antidepressant use on clinical outcomes of hepatitis B and C: a population-based study |
| title_sort | impact of depression and antidepressant use on clinical outcomes of hepatitis b and c a population based study |
| url | http://journals.lww.com/10.1097/HC9.0000000000000062 |
| work_keys_str_mv | AT abdelazizshaheen impactofdepressionandantidepressantuseonclinicaloutcomesofhepatitisbandcapopulationbasedstudy AT gilaadgkaplan impactofdepressionandantidepressantuseonclinicaloutcomesofhepatitisbandcapopulationbasedstudy AT keithasharkey impactofdepressionandantidepressantuseonclinicaloutcomesofhepatitisbandcapopulationbasedstudy AT bcordlethebe impactofdepressionandantidepressantuseonclinicaloutcomesofhepatitisbandcapopulationbasedstudy AT markgswain impactofdepressionandantidepressantuseonclinicaloutcomesofhepatitisbandcapopulationbasedstudy |