Patients First: HCV and Depression, by Alan Franciscus, Editor-in-Chief

In January 2015, I wrote about HCV and Depression.  Since that time, I have thought a lot about the link between depression and hepatitis C.  There does seem to be a pretty strong link between the two.  Add on to that just having a chronic disease, such as hepatitis C, it is not surprising that many people with hepatitis C are depressed.   

If you think about it there are many additional issues that increase the level of anxiety and depression that people with hepatitis C are now facing even more than before:  

• Will I be approved for the new medications by my insurance company?
• Will I be approved for treatment through a patient assistance program?
• Will I be able to afford the co-pays?
• Will the treatment work?
• What if I am not cured?
• What does my future hold?
• Will I be able to work?

There are also people, unfortunately, who have just given up and believe they have no choice at all—no insurance, no physician, no future. 

The list of uncertainties could go on and on and on. 

I’m bringing this up because I just recently ran across an article that startled me because it discussed Baby Boomers (without HCV) and the increased risk of suicide—Baby Boomers are at the highest risk for suicide and the risk increases as a Baby Boomer ages.   Additionally, the suicide rates were much higher in men than in women—In 2013, 78% of the 41,149 suicides in the U.S. were among men.  

Note:  Among Baby Boomer’s with HCV more than 2/3 are men.  

Remember, depression is an illness that is treatable.  There are resources at the end of this article and a link to the original article published in January 2015. 

I hope that people with HCV and their caregivers will be on the look-out for the signs of anxiety, depression and suicidal behavior to offer support.  Be sure to get professional help as needed.

Resources

• HCV and Depression: HCV Advocate, January 2015
• Easy C Guide to Depression
• Help‑4‑Hep
• Coping with Depression and Hepatitis C. 
• Overview of Depression
• Depression: Self-Help Tips
• HCV and Depression
• HCV and Mental Health Resources
• Managing Depression
• Medical Treatment for Depression

Source:
Baby boomers are killing themselves at an alarming rate, raising question: Why?

http://hcvadvocate.org/news/newsLetter/2015/advocate0815.html#5

Snapshots, by Alan Franciscus, Editor-in-Chief

Article: Depression rather than liver impairment reduces quality of life in patients with hepatitis C—LD Silva, et al
  Source: Rev Bras Psiquiatr. 2015 Jan-Mar;37(1):21-30. doi: 10.1590/1516-4446-2014-1446

 

Results and Conclusion: In the current study there were 124 patients (72 females; 52 males; mean age 53 yo).  The patients were given various clinical and psychiatric evaluations.  No patients were receiving HCV treatment.  Various in-person interviews were given to determine socio-economic information, health-related quality of life, income, smoking, alcohol and drug use. 

The study results found that 30.6% had major depressive disorder, which is consistent with other studies. The degree of major depressive disorder and other psychiatric disorders found in people with hepatitis C is associated with health-related quality of life rather than tied to the degree of liver fibrosis.  The authors noted that more attention needs to be devoted to “the implementation of integrated medical, psychiatric, and [that] psychological care may be helpful.”

 

The Bottom Line: Up to 70% of people with chronic hepatitis C have depressive disorders—this is a seven-fold higher rate than the general population.

 

Editorial Comment: Does HCV cause depression?  Many experts believe that the hepatitis C virus causes depression, but the exact mechanism hasn’t been completely understood.  There have been some studies that have shown that the hepatitis C virus passes the blood-brain barrier and there have been viral particles found in brain tissue.  Another possible reason for depressive disorders could potentially be the results of the immune system cells fighting off the virus in brain tissue.   

Regardless of what causes depression in people with hepatitis C, it is clear that curing hepatitis C also can increase the quality of life leading to a wide variety of improvements in health including mental health. It’s time that we recognize that we should treat everyone with hepatitis C regardless of the degree of liver damage—hepatitis C is NOT just a liver disease.

 

Article: Changes in characteristics of hepatitis C patients seen in a liver center in the United States during the last decade—N Talaat et al.
  Source: Journal of Viral Hepatitis Volume 22,Issue 5, pages 481–488, May 2015

 

Results and Conclusion: This was a retrospective study of the records of patients seen in liver clinics 1998-1999 (Era-1) compared to the records of patients seen 2011-2012 (Era-2)

The current study sought to describe the characteristics of people with HCV who were newly referred to liver clinics in Era-1 (538 patients). The records from Era-1 patients were compared to those of patients who were seen in Era-2 (810 patients).  Advanced liver disease was defined as cirrhosis, decompensated cirrhosis, or liver cancer.  

The patients in Era-2 were older (median age 56 vs 45 years), more likely to be Black (17.2% vs 11.6%) and had a longer interval between diagnosis and referral (median 4 years vs 2 years).  Genotype 1 was similar in both Era’s, but genotype 1a was 39.9% vs 53.8% in Era-2.  

Even though there was a higher percentage of treatment-experienced patients in the Era 2 patient group, the comparison showed that more than three quarters of the patients had never been treated.    

Era-2 patients were more likely to have advanced disease at referral (61.6% vs 51.5%)—with an   eightfold higher prevalence of HCC or liver cancer (21.6% vs 2.6%).

 

The Bottom Line:  The changes in the Era-2 patients points to important trends in the hepatitis C population.  These changes occurred over a relatively short period of time:   

• The majority of patients identified had not been treated.
• More patients had HCV genotype 1a – generally a more difficult genotype/subtype to treat.  This also reflects a change in the demographics of the HCV population of the United States.
• The aging of the HCV population is reflective of more advanced disease including an eight-fold increase in liver cancer.

Editorial Comment:  This study speaks volumes.  In this short period of time there has been a major advance in the rate of liver disease progression—most notably the increase in liver cancer is frightening.  


http://hcvadvocate.org/news/newsLetter/2015/advocate0515.html#4

Depression not linked to insulin resistance in patients with diabetes, HCV

Depression was not associated with peripheral insulin resistance among a cohort of patients with diabetes and hepatitis C virus infection, according to a study data published in the Journal of Viral Hepatitis.

Researchers enrolled 74 patients with diabetes (non-type 2) and HCV (mean age, 48 years) in the cross-sectional study and evaluated data after extensive comprehensive, clinical, histologic and metabolic testing to determine whether insulin resistance was associated with depression. Insulin was appraised through an insulin resistance test that measured steady-state plasma glucose and logistic regression analyses was used to evaluate predictors associated with depression, according to the research. 

“Depression was not associated with [insulin resistance] in our HCV-infected cohort,” the researchers concluded. “With the introduction of highly effective direct-acting anti-HCV treatments, the burden of HCV is anticipated to decrease significantly. However, considering the multifactorial nature of depression, interventions directed at other modifiable risk factors in at-risk individuals in this population are warranted.”

Read more...

Patients First: HCV and Depression —Alan Franciscus, Editor-in-Chief

People with hepatitis C face many challenges after being diagnosed.  These challenges can occur on a daily basis and seem to last from diagnosis until being cured.  These challenges can lead to increased anxiety and depression.  This article is about the many difficulties that people with hepatitis C face that can lead to depression, how to identify depression and some steps to deal with it. 

HCV and Depression
There are certain times during the hepatitis C journey that people may experience depression:

Diagnosis:  After a diagnosis of HCV, people are in shock, and many feelings may surface.  Some of the fears may include, but are not limited to:

• Becoming sick
• Feeling like you may infect someone else
• Suffering from hepatitis C 
• Being alone if friends and family turn away
• Loss of intimacy—both emotional and physical
• Being unable to start a family, and/or being unable to grow old with a family
• Facing death
• Losing income or not being able to support yourself or loved ones

The list is endless.   An additional issue is that now people are being denied access to treatment.  All of these matters can lead to anxiety and depression.  This time of year is even more difficult because some people experience additional holiday loneliness, isolation, and depression. 

Depression
Depression is a serious disease that affects about 1 in 4 American adults.  It can lead to death.  More importantly, it is a treatable illness.  It is not something that you can just snap out of in spite of what some people think.   Like hepatitis C, it is a silent disease and very stigmatized.  It is finally coming out of the shadows, and it can be successfully treated with counseling and medication.   

Warning Signs:  If you have thoughts of hurting yourself or others, this is an emergency that needs to be taken care of right away.  Call your doctor or nurse or one of the phone numbers listed at the end of this article.  People who work at crisis hotlines have been trained to help people who are in crisis mode. 

Signs and Symptoms of Depression

• Feeling sad, anxious or having an “empty” feeling
• Crying spells with no real explanation
• Feeling hopeless or pessimistic (gloomy or negative symptoms)
• Feeling helpless about life in general
• Not interested in family or social events, hobbies, sex or being with friends
• Constantly fatigued—tired all the time
• Cannot concentrate or make decisions
• Trouble with remembering things
• Having problems sleeping at night
• Losing weight, not eating, or eating too much and gaining weight
• Thinking about killing yourself or just even planning on killing yourself

Getting Help
There is help out there.  Think about talking to a professional.  Ask for help from your family, friends, and medical team.  If you cannot talk to family or friends, start with a support group.  This can be particularly useful if you are dealing with any issue related to hepatitis C. 

There are some general things that people can do to help conquer depression, but with severe depression, nothing replaces professional help.

Alcohol
Everyone with hepatitis C should stay away from alcohol, but if you are suffering from depression it is even more important.  Alcohol can also cause depression. 

Stress
Stress is a killer—that is a no-brainer.  There are many tips to reduce stress—exercise, finding balance, keeping a positive attitude, finding help, meditating, prayer, laughing, watching movies or any other pastime you find pleasurable.  Personally, when I get stressed out, I like to listen to one of my favorite comedians.  It always puts a smile on my face and sends me on my way to enjoy the rest of my day—at least when I have a light case of the blues.   

Realism
Try to get a realistic picture of your life and problems.  It sounds easier than it is but don’t dwell on the negative.  Find things that you enjoy and when you find yourself dwelling on the negative try turning it around and remember what it is positive about your life. 

Exercise
Walking, swimming, Qigong, running or almost any exercise can help to elevate the mood.  Think about joining a gym or a group exercise program.  Go slowly and if you have any physical problems get cleared by your medical provider.  Personally, I exercise every day to chase away the stress and blues. 

Balance
We live in a stressful world and trying to do everything can lead to stress, exhaustion, unrealistic expectations and depression.  Try to find balance – plan activities, build in down time and get plenty of rest. 

Keeping a Positive Attitude
A positive attitude will not cure depression, but it does offer hope for the future.  Remember, the way you feel now will not last forever. However, it is important to get a realistic picture of your physical and mental health.

These are all useful tips for less severe types of depression, but if you feel that you need more help, consider professional help. 

Medications
There are many medications—anti-anxiety and antidepressants—that can help.  Talk to a psychiatrist or your medical provider to find out if this would be a good fit for you.  Everyone is different, and every antidepressant works differently.  You and your medical provider may have to try more than one medication to find the one that works for you.  Most medicines have side effects, and all antidepressants have some side effects.  The most common side effects of antidepressants include headaches, nausea, jitters, nervousness and sexual side effects.  Some of the side effects may diminish over time.  Talk to your medical provider to make sure that the antidepressant is safe for the liver.

One of the best ways to fight depression is through knowledge and actions.  Learn as much about hepatitis C to reduce the fear of the unknown.  If you are depressed because you cannot get approved for a new treatment—check out Lucinda’s HealthWise article for tips to fight back and get approved for the new therapies.    We don’t want to harp on it too much, but get help for depression if you need it. 

Resources:

• Alcoholics Anonymous (AA)
  www.alcoholics-anonymous.org
  To find an AA group near you, look for “Alcoholics Anonymous” in any telephone directory or contact AA
• Hepatitis C Helpline
  877-HELP-4-HEP
  (877-435-7443)
  www.help4hep.org  
• National Institutes of Mental Health
  www.nimh.nih.gov/health/publications/depression
  /index.shtml
• National Suicide Prevention Lifeline, a 24/7 hotline for
  callers in the United States
  1-800-273 – TALK-and 1-800-SUICIDE
• Patient Assistance Programs
  http://www.hcvadvocate.org/hepatitis/factsheets_pdf
  /Patient_Assistance.pdf
  

http://hcvadvocate.org/news/newsLetter/2015/advocate0115.html#3