Hepatitis B and mental health

Photo by Anh Nguyen on Unsplash

​First published on Hepatitis Australia's website in May 2020

People with chronic hepatitis B have higher rates of depression and anxiety than the general population [1].
​
Let’s have a look at why this happens, and what we can do about it.

Reacting to your diagnosis

Adjustment to having a chronic (lifelong) disease may mean having to [2]:

• learn about hepatitis
• make lifestyle changes
• decide about disclosure to others
• decide on whether to take antiviral therapy. 

Research [3] has found that many people worry about getting liver cancer or infecting others, and that these concerns could increase the risk of mental health problems, particularly depression. Not understanding enough about hepatitis B or having no one to confide in can also cause social isolation and affect mental health [4].

Hepatitis B treatment

There is no cure yet for chronic hepatitis B, but there are medications which can control the virus and reduce the risk of serious complications from the condition. However, like all medications, the treatment for hepatitis B can cause side-effects for some people, including affecting your mental health. This is something you should discuss with your doctor, as well as whether you’d like any additional support during your treatment.
There are two main options for treatment [5]. Usually, the preferred option is nucleoside analogues (NAs), such as tenofovir and entecavir. These have fewer side effects than interferon, but often need to be taken for a long time, or even for life. Pegylated interferon (PEG-IFN) is an alternative and is usually given over 48 weeks.

Researchers [6] reviewed studies of people on interferon, and found: 

• significant depression occurred in 5% to 15% of people, with 21% to 58% experiencing milder symptoms
• anxiety was found in 1.4% to 3.3% of people. 

It is also possible that a history of depression, anxiety, bipolar disorder or post-traumatic stress disorder (PTSD), combined with interferon may cause worsening symptoms, or relapse [2]. 

Now let’s look at how to get help. 

Learn and connect

Learning about hepatitis B is a good way of combatting misconceptions. Great resources include the Hepatitis Australia website and the National Hepatitis Infoline (1800 437 222), which directs you to the community-based hepatitis organisation in your state or territory who provide friendly and confidential help.

In addition you can look at the Hep B Help website which has links to hepatitis B organisations plus multilingual factsheets, audio and video resources too.

You could also contact the hepatitis organisation in your state or territory and perhaps link up with people who have similar experiences. Alternatively, you could join an online forum like Hep Forums.
​
Talk to your partner, friends and family. By sharing your knowledge, you can reduce stigma - which might otherwise isolate you or interfere with you receiving treatment - while getting the support you need. You can read these tips on telling others you have hepatitis.

Get healthy

Eat a healthy, balanced diet and maintain a healthy weight. Avoid alcohol and smoking. You should talk to your doctor before using any non-prescription drugs or supplements.

Try to keep to a regular sleep pattern and regular exercise.
​
For general support for mental health you can check out Head To Health as well as Lifeline and Beyond Blue. If you need more support, don’t forget you can speak with your GP, specialist or ask for a referral to a psychologist or psychiatrist.

Medications and talking therapy

When mental health issues arise, many people find it helps see a psychologist for one‑to‑one, confidential talking therapy. Sessions usually include learning about the mental health condition, why it has happened and why it has persisted. The psychologist can work with you to use tools like relaxation, mindfulness and cognitive behavioural therapy (CBT) as a way of coping with difficult emotions [7,8].

It is also thought that antidepressants and anti-anxiety medications can work well for interferon-related depression and anxiety [9,10].

Pre-existing psychiatric medication may need to be changed or adjusted during antiviral treatment, for example to one less toxic to the liver. Psychiatric medications and support might need to continue for at least 6 to 12 weeks after finishing antiviral treatment [10].
​
For people at higher risk for depression, such as those with a history of depression or alcohol overuse, pre-emptive treatment with antidepressants can be started before beginning antiviral therapy [10].

References

1. Enescu, A., 2014. Psychosocial Issues in Patients with Chronic Hepatitis B and C. Current Health Sciences Journal, [Online]. 40(2), 93–96. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340448/ [Accessed 22 April 2020]. 
2. Substance Abuse and Mental Health Services Administration. Addressing Viral Hepatitis in People With Substance Use Disorders. Treatment Improvement Protocol (TIP) Series 53. HHS Publication No. (SMA) 11-4656. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2011.
3. Hajarizadeh, B., 2016. Hepatitis B-Related Concerns and Anxieties Among People With Chronic Hepatitis B in Australia. Hepatitis Monthly, [Online]. 16(6), e35566. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5010884/ [Accessed 22 April 2020].
4. Chan H, Yu CS, Li SY. Psychiatric morbidity in Chinese patients with chronic hepatitis B infection in a local infectious disease clinic. East Asian Arch Psychiatry. 2012;22(4):160-168
5. ASHM. 2018. Treatment of chronic hepatitis B virus infection. [ONLINE] Available at: https://www.hepatitisb.org.au/treatment-of-chronic-hepatitis-b-virus-infection/. [Accessed 22 April 2020].
6. Coman, H., 2013. Psychiatric Adverse Effects Of Interferon Therapy. Medicine and Pharmacy Reports, [Online]. 86(4), 318–320. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462448/ [Accessed 22 April 2020].
7. American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder. 3rd ed. Arlington, VA: Author; 2010. Retrieved March 4, 2011,
8. Wilson MP, Castillo EM, Batey AM. Hepatitis C and depressive symptoms: Psychological and social factors matter more than liver injury. International Journal of Psychiatry in Medicine. 2010;40(2):199–215.
9. Hu, C., 2017. Depression and anxiety caused by pegylated interferon treatment in patients with chronic hepatitis B and the therapeutic effects of escitalopram and alprazolam. Journal of Southern Medical University, [Online]. 20;37(9), 1201-1205. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28951362 [Accessed 22 April 2020].
10. Schaefer M, Mauss S. Hepatitis C treatment in patients with drug addiction: Clinical management of interferon-alpha-associated psychiatric side effects. Current Drug Abuse Reviews. 2008;1(2):177–187

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