The purpose of this study is to determine whether cognitive behavioral therapy (CBT) is
effective in the prevention of depression during interferon and ribavirin treatment for
hepatitis C infection.
The treatment for active hepatitis C in both HCV mono-infected and HCV/HIV co-infected
patients is a long and difficult course, involving combination therapy of interferon and
ribavirin for 6 to 12 months, a therapy with significant side effects. Up to 40% of patients
being treated will develop depression due to the medication, which in turn leads to
discontinuation of therapy and lost opportunities to prevent end stage liver disease. In
fact, the presence of depression prior to interferon treatment often excludes patients from
receiving interferon therapy, thereby denying them a potentially life-saving treatment.
Non-pharmacological therapies such as cognitive behavioral therapy (CBT) have demonstrated
efficacy in treating primary depression in numerous studies including in patients under
going treatment with chronic medical illness. CBT is a well-established treatment modality
and has been shown in several large randomized trials to be as effective, and in some cases
more effective, than antidepressants. CBT has also shown efficacy in preventing the
development of depression and other emotional disorders in high-risk populations. Offering
CBT prior to and during treatment with interferon to non-depressed patients is a unique
method that may reduce rates of depression and increase adherence to treatment without
exposing patients to the risk of an additional medication.
1. >21 years
2. Speak and read English to 5th grade level of higher.
3. Eligible and ready to begin Peg-Interferon and Ribavirin (PEG-IFN/RBV) therapy for
HCV at Mount Sinai's Primary Care practice or JMFC
4. HIV infected patients will need to have a CD4 count > 100 and have demonstrated
compliance to retroviral therapy
5. Not majorly depressed upon entry to study.
6. Signed informed consent to participate in CBT study
1. Majorly depressed (based on administration of the PHQ-9, score considered for Major
2. Admit to actively abusing illicit drugs or alcohol
3. Medical contraindications to a standard course of interferon/ribavirin therapy (eg:
severe anemia, uncontrolled congestive heart failure)
4. Less than one year of life expectancy
5. Current participation in CBT related psychotherapy
6. Participation in any psychotherapy beginning less than 6 months before CBT sessions
7. Initiated anti-depressant medication less than 6 months before CBT sessions begin
8. Severe comorbid psychiatric disease including bipolar disorder, severe personality
disorder, or psychotic disorder
9. Active suicidal ideation