From depletion of tryptophan to chronic fatigue and drug side effects, many factors may lead to depression during a hepatitis C infection. Here are eight essential steps to take for relief.
A loved one may be the first to notice symptoms of depression.
Hepatitis C is the leading cause of chronic liver disease in America, and for many, leads to depression. It’s estimated that hepatitis C depression affects up to 30 percent of people with the virus. And among those who have hepatitis C and use drugs, depression affects closer to 60 percent.
“Depression, anxiety, and substance abuse are all common with hepatitis C,” said Carlos Romero-Marrero, MD, a gastroenterology and liver disease specialist at the Cleveland Clinic in Ohio. “Being well-informed and knowing what to expect is the best defense against hepatitis C depression.”
Know the Risks of Hepatitis C Depression
“Hepatitis C and depression often go hand in hand,” said Xavier Jimenez, MD, a psychiatrist who treats patients with hepatitis C depression at the Cleveland Clinic’s Center for Behavioral Health. “The virus depletes a substance called tryptophan. You need tryptophan to make the brain chemical serotonin. Low serotonin may lead to depression.”
Besides the direct effect of hepatitis C on your brain, other factors contribute to the chance of developing depression with hepatitis C. For instance, “hepatitis C is a chronic infection that causes psychic distress due to stigma, anxiety, and symptoms like excessive fatigue,” explained Dr. Romero-Marrero. “It can reduce your quality of life, and that can lead to depression.”
In addition, Dr. Jimenez noted that “substance abuse, impulsivity, and other risky behaviors are all linked to depression.” Even if you did not have hepatitis C, substance abuse alone would increase your risk for depression.
Then there’s hepatitis C therapy which in many cases includes the drug interferon, that can be a major contributor to hepatitis C depression. “Interferon is a harsh treatment that can have toxic effects on the brain,” Jimenez said. “It may cause fatigue, insomnia, irritability, and even thoughts of suicide.” Newer drug treatmentswithout interferon promise fewer side effects like depression.
Dealing With Hepatitis C Depression
To overcome hepatitis C depression, you need to know your risk factors, the symptoms to look for, and how to work with your doctor on a treatment plan. “The idea that someone with depression or substance abuse can’t be successfully treated is a misconception,” said Romero-Marrero.
A review of hepatitis C therapy, published in the journal Clinical Infectious Diseases in 2013, found that treating substance abuse and depression along with hepatitis C can be successful. People with substance abuse or psychiatric disorders respond as well to hepatitis C treatment as people without these conditions.
“The key to success is to evaluate risk factors before treatment,” Jimenez said. “These risk factors include a history of depression or substance abuse, a family history of depression, and a poor social support system.”
“During an initial evaluation,” Romero-Marrero said, “it is important to get a caregiver or loved one involved. They may be the first to notice symptoms of depression. If substance abuse is part of the problem, it should be treated before starting hepatitis C therapy. It’s more important to go slow and get sober than to rush into treatment.”
8 Essential Steps to Take
- Let your doctor know about any history of substance abuse or depression and any family history of depression.
- Know all the symptoms of hepatitis C depression. These include sadness, fatigue, irritability, changes in sleep or appetite, and any thoughts of death or suicide. “Ask a loved one or caregiver to let you know if you are becoming more angry or irritable,” said Romero-Marrero. “Watch out for loss of interest in things that you once enjoyed.”
- Get treated for any substance abuse issues.
- If you have symptoms of depression or risk factors for depression, have a psychiatric evaluation before starting hepatitis C therapy.
- If you are diagnosed with depression, start depression treatment before starting interferon.
- If you have risk factors for depression, consider being treated before starting hepatitis C treatment with interferon. “We strongly recommend pretreatment for people with risk factors, to prevent depression,” Jimenez said.
- During hepatitis C therapy, always let your doctor know about any symptoms of depression or any substance abuse relapse.
- Help yourself beat depression by eating a healthy diet, being physically active, getting emotional support, avoiding stress, and getting enough sleep.
Evidence from clinical studies show medication can be effective. A review of eight studies on depression treatment before interferon therapy, published in 2013 in the journal Psychosomatics, concluded that antidepressant pretreatment with drugs called selective serotonin reuptake inhibitors (SSRIs) significantly lowers the frequency and severity of hepatitis C depression.
“SSRIs are the drugs of choice for hepatitis C depression,” Jimenez said. “These drugs can often be stopped after the body recovers from treatment. Studies show that combining talk therapy, called cognitive behavioral therapy, may improve treatment for most types of depression, and this may also be true for hepatitis C depression.”
There’s good reason to deal with depression before starting hepatitis C therapy. “If you are evaluated before treatment and monitored closely during treatment, it is rare that treatment needs to be interrupted because of depression,” said Romero-Marrero. “In most cases both depression and hepatitis C can be managed successfully.”