October Blog Special: Extrahepatic Manifestations of hepatitis C – Depression
Depression is an extrahepatic manifestation of hepatitis C (HCV) estimated at 1.5 to 4.0 times higher in people infected with hepatitis C than in the general population. Various studies have found that the hepatitis C virus infects the brain, causes inflammation and viral replication. HCV can cause neuropsychiatric problems that can include depression, fatigue, and cognitive issues. The higher levels of depression in people infected with hepatitis C is regardless of HCV disease severity, alcohol or drug use.
In addition to the hepatitis C virus exerting depressive effects on the brain and body, there are other well-known depressive symptoms that people with hepatitis C face when diagnosed with and who are living with hepatitis C.
Some of the issues and fears that may come up include:
- The potential of disease progression and death
- The stigma from hepatitis C
- Being infectious
- If treatment and cure will be within reach
There are many other feelings and symptoms of depression including: *
- Feeling sad, anxious or having an “empty” feeling
- Crying spells with no real explanation
- Feeling hopeless or pessimistic (gloomy or negative symptoms)
- Feeling guilty a lot
- Feeling like you are worthless
- Feeling helpless about life in general
- Not interested in family or social events, hobbies, sex, or being with friends
- Constantly tired all the time
- Cannot concentrate or make decisions
- Trouble with memory
- Having problems sleeping at night
- Not eating, losing weight
- Overeating and gaining a lot of weight
- Thinking about killing yourself, planning on killing yourself
*Adapted from National Institutes of Mental Health’s, Depression
There are many ways to get help for depression. A lot depends on how severe the depression is and how it affects someone. Self-care steps and help from others may help with mild depression. It may help to join a support group—in person or online. Moderate to severe depression requires more immediate and aggressive intervention with a medical provider.
Here are some simple tips to help with mild depression or feeling down and dealing with hepatitis C:
Hepatitis C worries:
- If you are worried about being infected with hepatitis C- find out as much as you can. What you find out is usually not as bad as what you have heard. Knowledge really is power.
- Treatment now can cure almost everyone. But it is expensive, and you may have to be work hard and advocate to get on treatment. There are resources at the end of this article to help.
- Getting Support—ask for help from family, friends, and your medical team. At first, only tell those people who you are close to and people who you are sure will provide the support that you need. Once you have support from the most important people in your life, then reach out to others who may be able to give you additional support.
- A word of caution: don’t tell anyone about your hepatitis C until you are ready! The exception is the people who will come in contact with your blood such as your medical providers. Also, be careful about telling people at work because you don’t know how they will handle it. It could make your life at work miserable if it gets around that you have hepatitis C or you can even lose your job.
- One proven way to get support is by attending a hepatitis C support group in your area or by joining an internet group such as Facebook.
- Exercise—is vital to stay healthy and it just might help with a case of the blues or mild depression. Talk with your doctor and nurse and ask if it is ok for you to exercise. You can get some terrific ideas from your doctor, nurse, exercise therapist or friends about different types of exercise. In fact, it would be helpful if you and a friend(s) agreed to exercise together. Walking is one of the best forms of exercise—most anyone can take up walking. Walking with a friend can make the time go by fast and will help both of you (or even more people) stick to an exercise plan. Just get a good pair of walking shoes.
- Balance—try to make sure that if you do something like exercise or running errands that you balance it with rest. For example, if you go for a walk, make sure you build some time in afterward for some rest so you can regain your energy. If you have particular chores that have to be done, do them when you find that you have the most energy—for some people, this is in the morning, for others it might be in the evening. Listen to what your body tells you and learn to adapt yourself to the situation and how you are feeling at the moment.
- Sleep—getting the right amount of sleep can be one of the most important steps you can take to stay healthy and upbeat. Most people need between 7 and 9 hours of sleep every night. There are many things you can do to help you sleep better, such as avoiding food and exercise too close to bedtime, and there are certain medications that can help you sleep—these include medicines that your doctor or nurse prescribe or drugs you can get at the local drugstore.
- Keep a positive attitude–it’s a lot easier said than done, but it is a fact that people who think positive thoughts are happier people. Feelings of gloom and doom are likely to make you feel sad and down. Try simple things like telling yourself that even though you are feeling tired now, you will feel better when this time passes. Don’t get caught up in thinking that you will feel this way all the time. It’s good to have a “real” picture of your health, but you don’t want to let your negative feelings drag you down and make you even more miserable.
- Stress can make you sick! Try to reduce any stress in your life you can control and learn about ways to help you to reduce your stress level. There are many things you can try such as yoga, meditation, prayer and ways to help reduce stress. Also, find time to have fun—laugh and do things that you like to do especially with good friends.
- Alcohol, drugs, and tobacco can affect how you feel and are harmful to your body and the liver. Try to stop or cut back on any harmful substance, if you can’t stop cut back and ask for help. Talk with your doctor, nurse, therapist, or a substance abuse counselor for help.
- Eating well is another way to stay healthy and to keep your mood upbeat. A healthy diet includes fruits, vegetables, whole grains and lean meat—try to stay away from too much sugar, fried and high-fat food. If possible talk with a person who can give you information and advice about food and nutrition— such as a registered dietician. Visit www.chosemyplate.gov for more information.
- Important: if you have a serious problem with depression or another mental illness—a person who has been trained and schooled in treating depression and mental illness can help. The medical person that has the “special skills” and education required to work in this area is called a psychiatrist. A psychiatrist can prescribe medication to take that can help with depression. There are other professionals such as psychologists, counselors, and licensed social workers who can provide support with one-on-one talk sessions, and group therapy.
What about Medications?
There are a lot of medicines that are used to treat depression and other mental problems. Talk with your doctor or psychiatrist to figure out if you need to take these medications. The drugs used to treat depression are called antidepressants. These medicines don’t work the same for everyone so you may have to try different ones to find out which antidepressant works best for you. Don’t give up–most people can be helped by working closely with their medical provider. Medicines to treat depression can have side effects depending on how the body reacts to them.
The most common side effects of antidepressants include:
- Headaches, stomach aches or feeling sick to the stomach,
- Being nervous, feeling jittery and,
- Certain sexual problems. The sexual problems can affect men and women, but the thing to remember is that they go away after stopping the antidepressant medication. For most people, the side effects will get better over time. There are also medications to help with some of the side effects of the antidepressant. It is important to remember that all drugs have to be processed by the liver so your doctor or nurse may monitor the antidepressant to make sure it is working for you and that your liver can handle the medication.
WHAT ABOUT HERBS? Some herbs may help with mild depression, but it is important to know that herbs have not been found to help with a major bout of depression. Herbs are like regular medicines, and they can affect how well other drugs work; some herbs can make you sick and damage the liver. If you are interested in taking herbs, use a well-known herbalist and remember to always tell your doctor or nurse about everything you are taking even if you think you will be judged—keeping you safe and healthy should be your goal.
Note: St. John’s Wort should not be taken at the same time that someone is being treated with an HIV or HCV protease inhibitor.
To read about other extrahepatic manifestations, click here
Resources for help with HCV medicines, click here
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