August 15, 2012Volume 7 - Issue 33

DynaMed Weekly Update

For the week ending August 10, 2012

Last week 743 articles were evaluated via DynaMed's Systematic Literature Surveillance and 309 were added to DynaMed content.   


Based on the editors' criteria of selecting "articles most likely to change clinical practice," one article of significant interest was selected for the DynaMed Weekly Update.

Feature Article

Prophylactic Escitalopram May Reduce Incidence of Interferon-Associated Depression in Patients with Chronic Hepatitis C and No History of Depression


Peginterferon Alfa plus ribavirin is the standard treatment for patients with chronic hepatitis C, but depression and other psychiatric adverse events are common complications of interferon treatment. Previous trials on depression prophylaxis with antidepressants have shown inconsistent results but most of these trials have been limited by either small sample size or short follow-up duration. In the largest trial to date, prophylactic escitalopram (Lexapro, Cipralex) was evaluated in adults with chronic hepatitis C and no history of psychiatric illness. A total of 208 patients were randomized to receive escitalopram 10 mg once daily vs. placebo beginning 2 weeks before the initiation of antiviral treatment with peginterferon alfa-2A plus ribavirin.  Antiviral therapy lasted for 24 or 48 weeks depending upon genotype. Escitalopram treatment continued for the duration of antiviral therapy.  Patients were followed for incident depression for 48-72 weeks (24 weeks after end of treatment).


All patients were observed for development of depressive symptoms for 12 weeks prior to the start of allocated treatment. During this period, 17% of the escitalopram group and 9% of the placebo group dropped out. The remaining 181 patients were included in the analysis, including 9 patients who were lost to follow-up.


Depression was defined as a score of ≥ 13 points on the Montgomery-Asberg Depression Rating Scale (MADRS, range 0-60 points). Depression developed in 32% with escitalopram vs. 59% with placebo (p < 0.001, NNT 4) (level 2 [mid-level] evidence). Major depression, defined by criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV developed in 8% vs. 19% (p = 0.031, NNT 9). There were no significant differences in sustained virologic response, treatment discontinuation, or serious adverse events (Ann Intern Med 2012 Jul 17;157(2):94). Peginterferon treatment is contraindicated in patients with preexisting depression or other psychiatric illness.


For more information see the Hepatitis C and Peginterferon Alfa
topics in DynaMed. 

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About DynaMed Weekly Update

Prepared by the clinician members of the DynaMed Editorial Team, DynaMed Weekly Update is a compilation of one to five articles selected from DynaMed's Systematic Literature Surveillance as articles most likely to change clinical practice.

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CME Information


0.25 AMA PRA Category I Credit(s)™
Family Physicians: 0.25 Prescribed credits
Nurse Practitioners: 0.25 Contact hours
Release Date: August 15, 2012
Expiration Date: August 15, 2013
Estimated Completion Time:
15 minutes
There is no fee for this activity.

To Receive Credit 
In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

Program Overview

Learning Objectives
Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.
Faculty Information
Alan Ehrlich, MD - Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company

Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.


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AAFP: Enduring Material activity, DynaMed Weekly Update, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 7, 2012. Term of approval is for one year from this date with the option of yearly renewal. Each Weekly Update is worth .25 Prescribed credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


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Program ID: 1102072X

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