How Is My Mental Health Affected By Hepatitis C Treatment?
Psychiatric side effects from hepatitis C treatment may impact your ability to take your medications, your quality of life, your relationships and your ability to work. Psychiatric complications are mainly associated with one of the hepatitis C treatment drugs, interferon-alpha. The good news is that these side effects are treatable.
Common psychiatric symptoms during interferon-alpha treatment are:
- Depression
- Irritability and mood swings
- Fatigue
- Anxiety
- Sleep problems
- Poor concentration (“brain fog”)
Rarely, you may experience suicidal thoughts and psychosis (loss of touch with reality). The good news is that nearly all psychiatric symptoms are reversible after completing interferon-alpha treatment. Most people feel better by 6 months after treatment, although some can feel better sooner.
Who Will Develop Psychiatric Complications During Hepatitis C Treatment?
Research suggests that about 1 in 4 people will develop a new diagnosis of depression during interferon-alpha treatment. Most people who develop depression during treatment will have mild to moderate symptoms. The biggest risk factor for developing depression during hepatitis C treatment occurs when you have several symptoms of depression before starting treatment. If you have a history of mental illness, including depression, it does not exclude you from receiving treatment as long as it is well controlled. Most people develop depression during hepatitis C treatment during the first 12 weeks of treatment.
Sleep problems, irritability and mood sensitivity are common side effects from interferon-alpha treatment. Again, if you have mild symptoms before you start treatment, these symptoms are likely to get worse.
How Can I Tell If I Have Depression During Hepatitis C Treatment?
It is true that many symptoms of depression are similar to side effects of interferon-alpha. If you have several of the following symptoms lasting more than 2 weeks during interferon-alpha treatment for nearly everyday, you may be suffering from depression caused by interferon-alpha treatment. The symptoms of depression are:
- Feeling sad or crying for no reason
- Loss of interest
- Sleeping too little or too much
- Feeling guilty or worthless
- Difficulty thinking or remembering things
- Changes in appetite
- Low energy or feeling more tired
- Feeling either slowed down or restless
- Hopelessness or repeated thoughts of death
If you are unsure if you have depression or anxiety, take one of the following questionnaires (PHQ-9 for depression or GAD-7 for anxiety) to determine if you should seek help from your doctor. A score of 10 or more means you should see your doctor for further assessment and possible treatment.
If I’m Depressed, Can’t I Overcome It With Positive Thinking?
Suffering from depression is no different than suffering from liver disease. Depression is not a sign of weakness - it is a complex medical illness that requires medical attention. This is the same for depression during hepatitis C treatment.
There are biological, psychological and social causes of depression. If you are depressed there may be more than one cause. We know that the treatment medication, interferon-alpha, is a common cause of depression. It temporarily alters your brain and not just your liver. Research studies have shown that serotonin, a neurotransmitter that is low in depression, is reduced in people on interferon-alpha treatment. This means that there are known biological causes of depression from interferon-alpha and we can offer specific treatments to correct this abnormality.
What Can I Do If I Have Psychiatric Symptoms During Hepatitis C Treatment?
There are several things that you can do to manage psychiatric symptoms, such as depression, during hepatitis C treatment.
- Stop using drugs and alcohol. They will affect your mood and mental health.
- Talk to your support network and let them know about these possible symptoms during your treatment. If they know, they may be able to help!
- Investigate support groups and programs (see www.liver.ca)
- Continue to exercise and eat healthy. Being physically healthy helps your mental health.
- Keep your treatment team in the loop. Let them know if you are having difficulty with any of the above listed symptoms.
- Find a psychiatrist for your hepatitis C treatment if you have a history of depression or other mental health concerns.
Treatment of depression caused by interferon-alpha usually involves social support and medication treatment. The main medications used for treating depression during hepatitis C treatment are antidepressants.
Antidepressants- Can be used safely in patients with hepatitis C and during interferon-alpha treatment
- Can be started before or during hepatitis C treatment for depression and/or anxiety
- Can provide benefit as early as 2 weeks and continue to experience some improvement over a 4 to 6 week period
- Are generally continued until interferon-alpha treatment is completed
- Are not addictive and can be gradually stopped at any time under the supervision of your doctor
In addition to antidepressants, other medications may be used to help with mood swings, irritability, anxiety or sleep disturbance. If you are having any of these psychiatric symptoms, you should talk to your doctor about potential treatments to choose the safest medications.
Talk therapies, also called “psychotherapy”, are also helpful for treating depression and other psychiatric symptoms. These therapies can improve your response to medications and help manage stressors during your liver treatment. The best treatment for depression combines psychotherapy and medications.
Support and Help
For more information about support groups in your area, visit www.liver.ca.
If you think you might need a psychiatric assessment to determine your risk before starting interferon-alpha treatment, or want help with your mental health, please ask your doctor for a referral to a psychiatrist or visit www.torontoliver.ca to learn about the Hepatology Mental Health Clinic at the Toronto Western Hospital Liver Centre.