SAN FRANCISCO — Antidepressants were safe and moderately effective in a study of 368 patients with end-stage liver disease, Dr. Jayant A. Talwalkar reported.
Little is known about the effects of antidepressants in patients with end-stage liver disease. The prevalence of depression was 41% in this population, higher than the estimated 30% in the general population. The mean age of the depressed patients was 54 years, and 44% were women, Dr. Talwalkar wrote in a poster presented at the annual meeting of the American Association for the Study of Liver Diseases.
The investigators reviewed the records of all patients who underwent a formal psychiatric consultation as part of their evaluation for a liver transplant. The patients were treated at one institution during a 2-year period.
Of the 150 patients identified as depressed, 44% had a prior history of depression and 83% were eligible for pharmacologic therapy for their depression. Antidepressants were prescribed for 83% of the 125 eligible patients, for a mean duration of 13 months.
Treated patients showed no significantly increased rates of worsening serum liver biochemistries, compared with the 264 patients who did not use antidepressants. The rates of development of new complications also did not differ between these two groups, reported Dr. Talwalkar of the Mayo Clinic, Rochester, Minn., and his associates.
“Pharmacologic therapy was not associated with a greater frequency of hepatic decompensation in patients with end-stage liver disease,” he wrote. The most common antidepressants prescribed were selective serotonin reuptake inhibitors, used by 83% of treated patients; 34% of patients required a change in antidepressant therapy or additional drugs for depression. Citalopram was used by 46% of patients, paroxetine by 20%, sertraline by 12%, and trazodone by 10%.
Dr. Talwalkar has received research funding from Pfizer Inc., the manufacturer of sertraline.
Antidepressant-related adverse events, reported in 21% of treated patients, included somnolence in 10%, nausea or diarrhea in 6%, and dry mouth in 3%.
The main causes of liver disease were hepatitis C infection, alcohol abuse, a combination of the two, and nonalcoholic steatohepatitis. The liver disease caused fatigue in 51%, pruritus in 10%, ascites in 70%, hepatic encephalopathy in 40%, hepatocellular carcinoma in 8%, and a prior variceal hemorrhage in 16%. Overall, 24% of patients were using β-blockers.
'Pharmacologic therapy was not associated with a greater frequency of hepatic decompensation.' DR. TALWALKAR