Hepatitis C: An In-Depth Guide

Depression

Depression is a word used to describe an emotional state in which you feel terribly sad for a couple of week or even months at a time. It's far worse than a case of general sadness because you also get a feeling of hopelessness and you take hardly any pleasure in things that previously made you happy. Your energy level may go way down to the point where even simple tasks like getting dressed in the morning seem like too much effort.

Sometimes depression is hard to recognize because it can sneak up over weeks or months. You may not even realize your mood has changed until someone close to you says something like, "You don't seem like yourself these days", or asks, "How come you're so quiet?"

This chart is meant as a guide only to help you figure out if depression is going unnoticed by you. The changes are ones that commonly occur when people sink into depression:

Changes related to depression
Changes to your physical self
  • More or less appetite, or a gain/loss in weight.
  • More or less sleep.
  • More or less activity.
  • More alcohol, cigarettes or drugs.
  • Less energy.
Changes to your social self
  • More time spent alone or feeling lonely.
  • More thoughts that nobody understands you or even cares how you're doing.
  • More time spent arguing with people.
  • Less time spent with friends or family members.
  • Less interest in sex.
Changes to your thinking self
  • More difficulty concentrating on tasks.
  • More difficulty remembering things.
  • More difficulty making decisions.
  • Less confidence at your place of work.
  • Thoughts of death or suicide.
Changes to your emotional self
  • More crying spells.
  • More frustration.
  • More angry outbursts or irritability.
  • Feeling like a failure or feeling guilty.
  • Feeling helpless or overwhelmed.
  • Less motivation.
  • Less enthusiasm.
Changes to your spiritual self
  • Feeling empty.
  • Loss of hope that things will get better, or expecting the worst in situations.
  • Loss of meaning or purpose in your life.
  • Less spiritual practice.
  • Less trust in people in general.

Cause

Peg-interferon is known to cause depression in some people. In addition, the following changes associated with hepatitis C and its treatment may cause or add to a depressed mood in some people:

  • More difficulty getting around or following through with normal daily activities.
  • Less ability to participate in leisure activities such as exercise or social events.
  • More difficulty keeping up at work.
  • Job loss resulting in less income and the end of a daily routine.
  • A shift in roles at home causing feelings of having lost your place in the family.
  • Less ability to make future plans.

Treatment

  • Choosing the type of treatment for depression that is best for you: Most people will choose one of the following three ways to treat their depression: antidepressant drugs, talk therapy or a combination of both

    Most people will choose one of the following three ways to treat their depression: antidepressant drugs, talk therapy or a combination of both. Antidepressant drug treatment combined with psychological (talk) therapy has a higher success rate than when medication is used by itself.

    The use of antidepressant drugs continues to grow and family doctors are becoming more comfortable in prescribing these medications, rather than referring their patient to a psychiatrist. The drugs can make the difference in getting a person through a particularly severe spell of depression. Second, provincial/territorial healthcare plans and insurance companies will probably cover a portion or the entire cost of most antidepressants. The major disadvantage to antidepressants is their side effects. The most common side effects associated with antidepressant use are dry mouth, weight gain, sleep problems and loss of sexual interest or ability.

    The advantages of talk therapy are also twofold. First, people in therapy learn coping skills that can be used throughout life during tough times. Second, talk therapy has no side effects. Talk therapy requires a time commitment (probably at least six sessions) and is emotionally hard work. Also, it may be more difficult to get your insurance company to reimburse the cost of therapy or there might be a limit on the number of sessions your insurance will cover.

  • Choosing the mental health professional right for you:

    Therapists in private practice charge by the session, so costs can mount quickly. But lack of money should not stop you from finding help. Many therapists charge according to a sliding scale, which means you can get a discount off the regular fee if you have a small income. Counselling at a local community mental health agency will take into account your ability to pay. Psychiatrists' fees are covered by provincial/territorial healthcare insurance. Medical social workers and psychologists attached to hospital programs are paid by the healthcare system. Check with your extended benefits plan to see if counselling services are covered such as through an Employee Assistance Program (EAP).

    The most frequently studied talk therapy is called cognitive behavioural therapy (CBT), in which you learn to recognize and change negative thinking patterns causing your distressed mood. Essentially, you can change how you feel by changing what you think and do. CBT is considered to be a first-line treatment of choice for people with depressive disorders. Many therapists use CBT along with other strategies to help you feel more like yourself again.

    Psychiatrists use talk therapy along with prescribing antidepressants. Registered mental health professionals who offer therapy but not drugs include psychologists, social workers and counsellors. Research shows that a therapist's professional degree and the type of therapy he or she uses are not as important as the quality of your relationship (that is, your trust and the positive feelings you have towards your therapist) in ensuring a successful outcome. It's important to take the time to carefully choose the right therapist for you.

  • Finding a mental health professional:
    • Your family physician may prescribe an antidepressant drug or make a direct referral to a psychiatrist, community counselling agency or hospital psychiatry/psychology/social work department.
    • You may find a good fit with a therapist through a recommendation from a family member or close friend.
    • Your local Hep C support group may know of a mental health professional who has experience in working with people living with Hep C.
    • Your community may have a mental health/family services agency that offers counselling services.
    • Your workplace may have an employee assistance program as part of your employee benefits package. Your employer will not be told you accessed counselling services or why, and the therapist's report will not be sent to your employee record.
    • Online search engines are available at the professional association websites for psychologists or social workers registered in your province/territory.
    • Your local telephone directory won't offer much detail, but will likely provide listings under the headings of counsellors, psychologists and social workers.

Tips

Add a daily exercise routine.

Try to be around other people, even if only for a little while each day.

Let people close to you help out with their company, encouragement, affection or ability just to listen.

Take part in activities, even if you don't especially want to. You may find you underestimate the amount of enjoyment you actually get from the experience. Low expectations are a product of negative thinking, so it's important to give yourself the opportunity to counter these thoughts and give yourself something to look forward to.

Set some priorities, then focus on them one at a time. Usually breaking a priority or task down into smaller parts helps give you more confidence as you take each small step closer to your goal.

Expect your mood to improve gradually. Feeling better does not occur overnight. Feeling a little better each day is how depression normally lifts.

Discuss with your doctor whether or not a prescription for antidepressant medication and/or referral to a therapist is right for you. Treatment for depression may be the answer if your usual coping skills aren't working or if your depressed mood significantly interferes with your life for a couple of weeks or more.

Recognize that you may need a professional diagnosis if you apply for disability benefits. There are licensed/registered therapists who are qualified to use a manual called the DSM-IV-TR in order to assess and diagnose depression. The DSM-IV-TR recognizes that a person may have a mental disorder due to a general medical condition. Some people fear being labelled with a mental health disorder and dealing with that stigma. However, a diagnosis based on the DSM-IV-TR may be required by insurance companies.