Re: interpeting biopsy result and possibility of treating depression w/anti-depressa

Posted By Richard Axley on April 25, 1999 at 12:18:24
I started Intron A therapy a little over a month ago. My doctor discontined Intron A 9 days ago because my WBC dropped to 2,500 (and reason #2 was, he said, because I reported depression). I talked to the "Be in Charge" program and they said depression was commonally (excuse all spelling) treated with anti-depressents by people taking the Intron A therapy. I guess I can handle the depression, but I would like to alleviate it, as the physical side effects of Intron A are for me minimal (exc. for the WBC). I don't think he was aware (I think he is a GP) about lots of people who take Intron A also take anti-depressants-I think he just thought the best way was to discontinue.) Anyway he is going  to send me to a psychiatrist who will I guess make the anti-depressant decision. Any papers out there I can reference and bring with me to the meeting with the psychiatrist (that support the anti-depressant argument!)?
I attended a Hep C support group last week (extremely helpful) and people were talking about the various "stages" of the disease-phase I or stage I through stage III (bridging fibrosis).  How many rating systems are there for quantifing biopsy results? Pasted here is my pathology report verbatim:

Microscopic/diagnosis:
Biopsy shows two needle biopsies of the liver. The sections shows loss of normal architecture of the liver parenchyma. Various size nodules are separated by fibrous tissue septa. Periportal piecemeal necrosis is present (score-1). There are small foci of inflammation in the parenchyma (score-2). There is also some bridging necrosis (score -4). Mild fatty change is also noted in the parenchyma. Portal inflammation is moderate (score-2. Moderate fibrosis is present as confirmed by the trichrome or connective tissue stains.
Final DX: Liver biopsy showing moderate chronic hepatitis.
Could you tell me what stage I'm in? I've heard you don't need treatment if you are stage I or stage II. I tolerate the Intron A  well (exc. for WBC as I said) except for the hopefully treatable depression. My PCR was 57,000 before treatment. Is it a big deal (does it give virus a chance to mutate and be resistant to Intron A) to temporarily discontinue? I have read some other posts where you said it is usually better treated early with ? a low viral load. I got the hep C test when it first came out, early '90s. Earliest I could have contracted it was about '83 (illegal drugs). I've been clean and sober since about 90 and 1991.
Thanks in advance, you and this forum really perform a public service for hep c sufferers.
Richard Axley
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[HFHSM.D.-D.M.]

Posted By HFHSM.D.-D.M. on April 30, 1999 at 16:51:42

Dear Richard Axley:
I appreciated your questions and Ill try to make some comments to address all of them.
Depression is a common side effect of interferon or combination therapy for hepatitis C.  We find that anti-depressant medications can be very effective in this setting and some hepatologists routinely use anti-depressant medication in their patients receiving interferon based treatment.  Here are a few references you can give to your psychiatrist.  Hopefully, she/he will be aware of some of these problems and the potential role of anti-depressants.  
Yates WR. Gleason O. Hepatitis C and depression.  Depression & Anxiety. 7(4):188-93, 1998.
Levenson JL. Fallon HJ. Fluoxetine treatment of depression caused by interferon-alpha American Journal of Gastroenterology. 88(5):760-1, 1993 May.
I talk about the importance of liver biopsy quite a bit.  I always make it clear that the most important thing for me by far is the level of fibrosis.  There are many types of staging systems for liver biopsys and it would not make sense for me to go through all of them.  One of the commonly used ones has four stages or grades of fibrosis  and bridging fibrosis is typically stage 3.
It is true that patients with low viral titers (less than 200,000 copies/ml) respond particularly well to therapy and I know of no reason to think that stopping interferon early will result in drug resistant mutant forms of the virus.  Finally, I know a Dr. Robert Gish in California.  If this is the liver specialist you have an opportunity to see, I would recommend him without hesitation.  
Good luck. If you have additional information or questions, I would invite you to post the material to MEDHELP.  At Henry Ford, we have an active group of liver specialists and we have an interest in the care and research of hepatitis C.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation.  Always check with your personal physician when you have a question pertaining to your health.  











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interpeting biopsy result and possibility of treating depression w/anti-depressa Richard Axley 4/30/1999
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Re: interpeting biopsy result and possibility of treating depression w/anti-depressa HFHSM.D.-D.M. 5/07/1999
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