The hepatitis C virus (HCV) affects an estimated 180 million worldwide and is a major cause of chronic liver disease. Although there is a cure, treatment is sometimes unsuccessful or not an option for patients. As a result, clinicians are finding an increased correlation with clinical depression and HCV infection. According to the DSM-IV criteria (the Diagnostic and Statistical Manual of Mental Disorders), reported prevalence rates for major depressive disorder are higher in those with HCV:
Ranging from 24 to 70 percent with chronic Hepatitis C infection
Ranging from 6 to 10 percent in the general population
Although calculating the exact prevalence of depression among patients with chronic hepatitis C can be complicated as a result of inconsistent measures of depression and its symptoms, most experts will agree that the prevalence of depression among folks who are living with chronic hepatitis C is significantly higher than the general population, and both patients and healthcare providers must consider its implications when determining the impact of depression on continued therapies and treatment regimens.
Major depressive disorder, or simply, depression, is characterized by depressed mood and the inability to experience normally pleasurable events such as exercise, eating, or sexual and social interaction for a period that lasts at least two weeks in a row or more. Depression is also accompanied by four or more of the following items:
Feeling emptiness or sadness that is overwhelming
Disinterest or a lack of pleasure in daily activities
Weight changes and/or appetite changes
Inconsistent or interrupted sleep cycles
Changes in physical activity
Loss of energy and/or a feeling of fatigue
Feeling worthless or guilty
Trouble making decisions, focusing on tasks, or concentrating on activities
Thoughts about suicide and death
Causes of HCV depression
Since there are a myriad of factors that contribute to depression, it’s often difficult to discern the relationship between chronic HCV infection and depression. Researchers and clinicians believe that folks who are living with chronic hepatitis C are most likely to experience depression as a result of a combination of factors related to an HCV infection such as: emotional and physical health of the patient, personal beliefs, access to treatment options, an individual’s personal support system, and physiological symptoms of the infection. The following four elements are commonly thought to contribute to depression in someone who’s living with HCV:
Interferon/Ribavirin Therapy – Although there are recent advancements in the treatment for hepatitis c, those therapies are not accessible to all patients, and the older, less-successful combination of interferon and ribavirin is still widely administered. The standard for many years, interferon and ribavirin therapy is often accompanied by severe side-effects, and some studies have suggested that a chemically-induced depression occurs in 20-40% of all patients treated with this regimen. The resulting depression from an interferon/ribavirin combination therapy can impact patient compliance, due to premature discontinuation, and further reduces the likelihood of a sustained virological response (SVR).
Pre-existing condition – Some folks acquire an HCV infection as a result of high-risk behaviors, and it’s been suggested that those high-risk behaviors are triggered by preexisting conditions such as depression or post-traumatic stress disorder. Since there is high prevalence of depression in individuals who engage in high-risk behaviors, it is thought that for those individuals, HCV is not the direct cause of the depression but a contributing factor to its continued impact on someone’s quality of life.
Psychological impact of HCV – Having a chronic infection that can impede physical functions is often associated with burden, distress, and depression. Both knowledge of the infection and the symptoms from an HCV infection can reduce one’s quality of life, and that can be the springboard for depression. Health experts have found that patients with cirrhosis often exhibit lower quality of life scores, and that psychological burden leads to mental health concerns and increased risk of depression.
Biological result of HCV – Some studies have suggested that the hepatitis C virus affects the central nervous system as the viral particles cause chemical changes, and that can lead to HCV-induced depression. Things like brain oxidation, energy metabolism changes, neuro-cognitive ability impairment, and increased fatigue have all been linked to HCV, and those findings support the basis for the theory that the hepatitis C infection itself leads depression. While additional research is needed to link the two, studies have demonstrated indirect effects of HCV on mental health, which leads researchers to believe that HCV can directly impact a patient’s psychological well-being after a diagnosis and while undergoing treatment.
What to do if you’re experiencing depression
It’s important to pay close attention to any changes in mood, feelings of despair, or if you are having suicidal thoughts. Patients and physicians should evaluate any and all indications of depression, as that may play a role in treatment regimens. Knowing what to look for and the mechanisms that can trigger depression can help one establish a proactive approach, but if you are already experiencing any of the symptoms mentioned after being diagnosed with hepatitis C or while undergoing treatment, you should seek help immediately.
You are a not alone – many others have felt similarly upon a diagnosis, and there are people who can help. A good first step can be calling one of the national suicide hotlines at 1.800.SUICIDE (1.800.784.2433) or 1.800.273.TALK (1.800.273.8255). You can also go to your local emergency room and tell them you are struggling; they can keep you safe.
Krauss M. Risks and Mechanisms of Depression in HCV, Depression Associated With HCV Infection and Its Therapy: Impact on Patient Management, Clinical Care Options, LLC, March 2007.
Bourgeois J, Lorenzo Rossaro, MD, and Robert D. Canning, PhD. Depression as Co-Pilot: Clinical Implications of Hepatitis C and Interferon/Ribavirin Treatment, Psychiatric Times, April 2005.
Hauser P, Morasco BJ, Linke A, et al. Antiviral Completion Rates and Sustained Viral Response in Hepatitis C Patients With and Without Preexisting Major Depressive Disorder. Psychosomatics. 2009;50(5):500-505. doi:10.1176/appi.psy.50.5.500.
YH. Interferon-Induced Depression in Chronic Hepatitis C, Journal of Antimicrobial Chemotherapy, September 2006.