Depression and Fatigue: The HCV Connection

[Guest guest]

Sally,

Great research. I wonder how long if ever it takes the brain to get

better if the little buggies are removed. Some of the problems noted

seemed to fit but I think were worsened rather than created by hep.

Interesting,

Mike

>

>

> Depression and Medication

>

> One of the most significant of the potential adverse effects of

interferon

> and interferon/ribavirin therapy for hepatitis C (HCV) infection is

the

> development or worsening of depression and other psychiatric

diseases.

>

> In fact, the prescribing information for both pegylated interferons

warn

> that the use of these drugs can result in life-threatening or fatal

> neuropsychiatric events, including depression, suicidal and

homicidal

> ideation, aggressive behavior and suicide.

>

> We know that the medications used to treat HCV infection can cause

disorders

> of mood and thought. But can HCV infection itself cause mental and

> emotional problems, even in the absence of medications?

>

> In this article, we will review some clinical studies examining the

direct

> effect of hepatitis C infection on emotional and cognitive function,

> including depression, impaired mental processing, fatigue, and

quality of

> life.

>

> The Origins of Depression

>

> While depression is a common finding among people infected with HCV,

> determining the cause of the depression is not simple.

>

> There are several possible determinants of depression in the

context of HCV

> infection.

>

> Depression may be a direct physiological result of HCV infection.

>

> One study examining a possible biological explanation for anxiety

and

> depression in HCV patients found evidence of mild, but significant

> neurocognitive impairment in patients with HCV infection.

>

> This impairment could not be attributed to substance abuse,

coexistent

> depression or hepatic encephalopathy.

>

> The study authors note that the detection of HCV genetic material

in brain

> tissue raises the possibility that HCV infection of the central

nervous

> system may be a cause of psychological symptoms, fatigue and

cognitive

> impairment.

>

> Depression may be a psychological response to the anxiety

associated with

> HCV diagnosis.

>

> A study examined the incidence and degree of depression among

various groups

> of HCV patients. Of their study group, about 22 percent had

depression and

> about 15 percent had anxiety.

>

> The researchers found that older patients (50 years and older) were

> significantly more depressed than younger patients. Those advised

not to

> undergo an interferon therapy were also significantly depressed and

anxious.

>

>

> Additionally, they found that patients recently diagnosed with HCV

infection

> had significantly lower test scores for depression and anxiety than

the

> group who had been diagnosed more than five years previously, and

that

> recently diagnosed chronic hepatitis C patients also showed the

highest

> levels of problem-solving behavior.

>

> Depression may be a psychological reaction to other physical

illnesses

> associated with HCV.

>

> Studies have found a relationship between hepatitis C infection,

depression,

> and fatigue.

>

> A study of 50 patients with HCV found that 14 had significant

depression,

> and that the severity of depressive symptoms was associated with

functional

> disability.

>

> These authors conclude that disability and fatigue are more closely

related

> to depression severity than to hepatic disease severity, and

propose that

> antidepressant medications for HCV patients C may improve fatigue

and

> functioning.

>

> Another study of depression and fatigue in 115 HCV patients

compared levels

> of fatigue with history of intravenous drug use, alcohol history,

> transaminase levels and liver biopsy findings.

>

> They found that fatigue weakly correlated with the level of

fibrosis, but

> was strongly associated with depression, anxiety, somatization,

> interpersonal sensitivity and hostility.

>

> Depression may also result from a combination of psychological,

emotional

> and physical factors.

>

> Cognitive Impairment

>

> Studies have demonstrated that some people infected with HCV may

have a

> decreased ability to perform mental tasks.

>

> In one study, a group of 66 patients with chronic hepatitis C and 14

> patients with other chronic liver diseases were administered a

battery of

> psychological tests to assess attention, learning, memory, and

psychomotor

> speed.

>

> Over 80 percent of the subject group had impairments in attention

span and

> concentration.

>

> Researchers found a significant relationship between liver fibrosis

stage

> and test performance, with greater fibrosis associated with poorer

> performance on tests of cognitve function.

>

> This suggests that liver injury may result in cognitive problems

even before

> the development of cirrhosis.

>

> In another study of 21 chronically infected HCV patients,

researchers

> assessed patients subjective cognitive dysfunction, depression,

anxiety, and

> fatigue, and compared these symptom areas to cognitive tests

assessing

> learning, memory, visual attention, psychomotor speed, and mental

> flexibility.

>

> Results revealed cognitive impairment in 9 to 38 percent of

patients. In

> this group, the degree of cognitive impairment was related to

degree of

> liver fibrosis.

>

> Researchers found no relationship between the patient's reports of

> subjective symptoms, such as depression and anxiety, and the degree

of

> impairment on objective cognitive tasks, such as learning, memory,

and

> attention span.

>

> Their findings suggest that a significant portion of HCV patients

experience

> cognitive difficulties that may interfere with the performance of

ordinary

> tasks, thus decreasing quality of life and contributing to anxiety

and

> depression.

>

> Another study examined the cognitive functioning of HCV patients

directly

> through the use of P300 event-related potentials, a sensitive test

of the

> brain's electrical activity.

>

> These researchers found that their subjects demonstrated a slight,

but

> significant neurocognitive impairment. These findings were not

related to

> the degree of liver damage, biochemical activity of hepatitis,

severity of

> fatigue or mental health impairment.

>

> Quality of Life

>

> Several studies have examined the relationships between hepatitis C

> infection and quality of life.

>

> These studies typically consider the impact of depression, anxiety,

> co-existing psychiatric illness and substance abuse as factors

affecting the

> quality of life in HCV patients.

>

> One study evaluated nearly 160 subjects with chronic HCV infection

for

> quality of life using standardized assessment tools. Over 60

percent of the

> group had cirrhosis.

>

> The study authors report that in their group of subjects, a

decreased

> quality of life was associated with more advanced cirrhosis (Child-

Pugh

> class B and C), depression, and a poorer understanding of their

disease.

>

> Another study identified that while patients with HCV infection and

> compensated cirrhosis have a decreased quality of life,

decompensated

> cirrhosis is associated with even greater decreases in quality of

life.

>

> Diminished quality of life was associated with the severity of liver

> failure, neuropsychological abnormalities and treatment with beta-

blockers

> or diuretics.

>

> The authors note that administration of beta-blocker and diuretic

> medications in cirrhotic outpatients with prior episodes of

decompensation

> appears to improve quality of life.

>

> An interesting study examined quality of life from a different

perspective.

> These researchers found that people with HCV also experience a

decreased

> quality of life as a result of prejudice and bias on the part of

the medical

> establishment.

>

> In this study, 260 patients were interviewed, and 147 study

participants

> reported that they had been stigmatized as a result of their HCV

infection.

>

> Women were more likely to report perceived stigmatization than men,

and

> stigmatization was associated with anxiety, depression, decreased

quality of

> life, loss of control and difficulty coping.

>

> Study participants also reported problems in their health care and

work

> environment, as well as with family members.

>

> The study authors suggest that physicians and other care providers

should be

> aware of the existence and impact of such negative stereotyping.

>

> Conclusions

>

> a.. There is an established relationship between HCV infection,

depression

> and fatigue

>

>

> b.. There is evidence that depression may be caused by infection

of the

> central nervous system by the hepatitis c virus

>

>

> c.. Depression strongly correlates with age over 50 years,

ineligibility

> for treatment, and length of time since HCV diagnosis

>

>

> d.. Depression correlates more highly with fatigue than with

physical

> damage to the liver (fibrosis)

>

>

> e.. HCV infection appears to directly influence the performance

of mental

> tasks

>

>

> f.. Impaired cognitive performance contributes to depression and

decreased

> quality of life

>

>

> g.. HCV infection results in a decreased quality of life caused by

> depression, fatigue and decreased cognitive performance

>

>

> h.. Prejudice and stigmatization against HCV patients on the part

of the

> medical establishment contribute to decreased quality of life Source

>

> PEG-Intron Prescribing Information. Schering Corporation, 2003.

>

> Pegasys Prescribing Information. Hoffmann-La Roche Inc., 2002-

2004.

>

> Forton DM, et al. Cerebral dysfunction in chronic hepatitis C

infection. J

> Viral Hepat. 2003 Mar;10(2):81-6.

>

> Kraus MR, et al. Emotional state, coping styles, and somatic

variables in

> patients with chronic hepatitis C. Psychosomatics. 2000

> Sep-Oct;41(5):377-84.

>

> Dwight MM, et al. Depression, fatigue, and functional disability in

patients

> with chronic hepatitis C. J Psychosom Res. 2000 Nov;49(5):311-7.

>

> Mc J, et al. Fatigue and psychological disorders in chronic

hepatitis

> C. J Gastroenterol Hepatol. 2002 Feb;17(2):171-6.

>

> Hilsabeck RC, et al. Neuropsychological impairment in patients with

chronic

> hepatitis C. Hepatology. 2002 Feb;35(2):440-6.

>

> Hilsabeck RC, et al. Cognitive functioning and psychiatric

symptomatology in

> patients with chronic hepatitis C. J Int Neuropsychol Soc. 2003

> Sep;9(6):847-54.

>

> Kramer L, et al. Subclinical impairment of brain function in

chronic

> hepatitis C infection. J Hepatol. 2002 Sep;37(3):349-54.

>

> Gallegos-Orozco JF, et al. Health-related quality of life and

depression in

> patients with chronic hepatitis C. Arch Med Res. 2003 Mar-Apr;34

(2):124-9.

>

> Cordoba J, et al. Quality of life and cognitive function in

hepatitis C at

> different stages of liver disease. J Hepatol. 2003 Aug;39(2):231-

8.

>

> Zickmund S, et al. " They treated me like a leper " . Stigmatization

and the

> quality of life of patients with hepatitis C. J Gen Intern Med. 2003

> Oct;18(10):835-44.

>

> Reviewed October 5, 2005 by V. J. , RN, BSN, MA.

>

>

>

http://www.hepatitisneighborhood.com/content/finding_support/coping_em

otiona

> l_support_2001.aspx?randStr=

>

>

[Guest guest]

Hep certainly doesn't help anything. You asked my diagnosis? At this time

the official is Severe Depression with Suicidal Ideation and ADHD. Along

with that but not included in the official diagnosis is a type of

personality separation. I can be different people. I'm usually aware of it,

but can't control it. Mostly this was caused by very early trauma and being

unable to deal with it, but having realized the trauma and coming to deal

with it, accepting that I *have* survived it, the personality splits are

melding.

And then there's the Shaman thing. I don't consider that a mental illness,

but some probably would.

The paper I copied below is part of a larger body of research that speaks to

the severe effects of HCV on the nervous system, from the brain down to the

nerve impulses in the limbs. Its not just a disease of the liver.

Sally

Re: Depression and Fatigue: The HCV

Connection

Sally,

Great research. I wonder how long if ever it takes the brain to get

better if the little buggies are removed. Some of the problems noted

seemed to fit but I think were worsened rather than created by hep.

Interesting,

Mike

[Guest guest]

I dont know folks its been close to 3yrs for me and its still snafu .

,,,,,,,,,,,,but then it was allways been like that to some extent the hcv just

brought the best out

[Guest guest]

What's three years?

Sally

RE: Re: Depression and Fatigue: The HCV

Connection

I dont know folks its been close to 3yrs for me and its still snafu .

,,,,,,,,,,,,but then it was allways been like that to some extent the hcv

just brought the best out

[Guest guest]

Sally, comming up on 3yrs negitive for hep did 18 months on inf and riba , say

did you ever read the prod info slip says riba is a, mutigen, carcinagenic ,

genatoxic i guess that means in a few years i will turn into a pile of

cancerous slime along with many others so far i have avoided any after tx

peremant sides unlike quite a few ,but i fear their maybe a big monster just

around the bend named riba . eric

[Guest guest]

Sally,

I find you diagnosis the best I have ever had. The only things I

found off a bit are I almost never have experienced suisidal ideation

at least that I am aware of. Once or twice thought about it like

many teens but never got right down to it or dwelled on it for a long

time. Perhaps reckless driving in young years was a form of

suiside.

I studied reckless driving and found a better fit with another

personality type I can't think of the name sociopath perhaps? But

it's people who are disassociated somewhat from others and have a

total lack of the normal fear reaction. For such people normal fear

responce is strangely pleasant and thrilling not freightening.

For these people combat and car recks are like a fun ride on a roller

coaster for most. Thrilling but not actually scary it just makes em

feel all alive and tingly with excitement. That's how I feel when I

crawl out of a wreck all happy to be alive and all tingly at the

thrill. No physical fear except heights for some reason.

When such people are unlucky enough to be raised with out values they

often become criminals and sometimes killers. When they have good

values they make good cops and firemen and often do crazy stuff to

save other people in dangerous situations. Think I'm no fireman but

much closer to that then a criminal since I can't take hurting others

very well.

May be that's what you meant and I missunderstood it.

I may however be on a boat trip down da nile as they say.

I did several times feel quite depressed but strangley think I am

only moderately depressed now but do expect to have all of the above

bad things once baby and wifey depart.

I an aware of being depressed now but feel much relief having other

folks to talk with. I want to live so bad I would crawl thru broken

glass every day to take my meds. My motto is survive.

One day I sat in bed and decided the marriage was killing me and

living meant getting away from my wife or getting off chemo and dying

before too many years. By the time I was cognizant of having that

though the marriage was dust. So I do think I want to live.

You're the best shink I ever even heard of. You were so perfect on

the wife. I have never seen any match so perfect as the she is with

the psyc diagnostic guidelines. It was like some one did a case

study of her life and said let's describe Mike's wife in shrink terms.

It made me understand how powerless I was to make it work long term.

All it took to go direclty from crazy love and unhealthy idealization

to hate was a temporary decraese in attention and constant pets.

Amazed by your insight. You are not deluding youself regarding your

goddes wisdom.

Admiringly,

Mike

>

> Hep certainly doesn't help anything. You asked my diagnosis? At

this time

> the official is Severe Depression with Suicidal Ideation and ADHD.

Along

> with that but not included in the official diagnosis is a type of

> personality separation. I can be different people. I'm usually

aware of it,

> but can't control it. Mostly this was caused by very early trauma

and being

> unable to deal with it, but having realized the trauma and coming

to deal

> with it, accepting that I *have* survived it, the personality

splits are

> melding.

>

> And then there's the Shaman thing. I don't consider that a mental

illness,

> but some probably would.

>

> The paper I copied below is part of a larger body of research that

speaks to

> the severe effects of HCV on the nervous system, from the brain

down to the

> nerve impulses in the limbs. Its not just a disease of the liver.

>

> Sally

>

> Re: Depression and Fatigue:

The HCV

> Connection

>

>

> Sally,

>

> Great research. I wonder how long if ever it takes the brain to

get

> better if the little buggies are removed. Some of the problems

noted

> seemed to fit but I think were worsened rather than created by hep.

>

> Interesting,

>

> Mike

>

[Guest guest]

Broken glass ,i had to do that craw and walk through a mine feild too . I

thought that inf / riba was going to kill me several times but keep going

anyway.

[Guest guest]

Mike what state and town are you in ,im in not so maryland baltimore .

[Guest guest]

,

City of Virginia Beach, Virginia now but soon as the house sells

moving to a place called Willoughby nearby in Virginia just 10 miles

inside the mouth of the Chesapeak.

Gonna get a nice reasonable appartment right on the beach for only

$800 bucks which is way cheap for a water front apt. I mean right on

the beach the front yard is sand. Swim and fish from the front yard.

Gonna get a boat when I feel better maybe named " Ex Wife Sucs " but

still open to other names. Guess I'd have to change it anyway when

baby learns to read. Besides it does seem a bit mean spirited and

thats not me during normal times. Probably name it " Mali's Boat "

after my daughter. She likes boats in the tub says boat boat.

Yeah in the spring the big rock fish group up around the sunken Ces

bay tunnel which is covered in bolders and when the tide runns they

lay down stream like trout behind a sunken log and chow down. You

catch small fish croakers 6-8 in and use em for bait.

I may not be ready this spring but summer and fall are still a fine

time to cast plugs around the ches bay islands and bottom fish or

troll for blues and rock.

Balt is close by. Once I get settled in this summer maybe we could

fish some and chase geriatric chicks on the beach. It's not a fancy

place some minor crime stealing and that stuff but overall a low

violent crime rate. I kinda like it there and lived across the

street as a child.

Mike

>

> Mike what state and town are you in ,im in not so maryland

baltimore .

>

>

>

[Guest guest]

,

Years past I lived in Silver Spring and Takoma Park. Daughter went to RICA

Rockville, special school for severely emotionally disturbed kids. Younger

daughter worked in a lab at NIH.

Sally

Re: Re: Depression and Fatigue: The HCV

Connection

Mike what state and town are you in ,im in not so maryland baltimore .

[Guest guest]

Mike,

Sounds like a plan. Don't get the blues here on the west coast. And I really

miss the soft shell crabs. Yummm!! Have to say that other than the climate,

the area down there is great. Had a condo in burg years back. Oh,

that was heavenly. Even the night we came home in a rainstorm and found the

water sleucing through the light switch box on the wall in the foyer. I

opted not to switch on the light at that moment.

I do love weather, just hate humid climates. We're having fun weather here

right now. Rain, rain, rain and more rain. And then some more rain. I guess

I should have toned down those rain dances, huh?

, you hang in there. If you care to talk about it I'm interested in your

head injury. What happened, when and how? And what sort of rehabilitation

you've had. Older daughter runs an independent living center for head

injured adults. She's pretty sharp.

Happy Nude Ears everyone. Hope Michele is having a good one too.

Sally

Re: Depression and Fatigue: The HCV

Connection

,

City of Virginia Beach, Virginia now but soon as the house sells

moving to a place called Willoughby nearby in Virginia just 10 miles

inside the mouth of the Chesapeak.

Gonna get a nice reasonable appartment right on the beach for only

$800 bucks which is way cheap for a water front apt. I mean right on

the beach the front yard is sand. Swim and fish from the front yard.

Gonna get a boat when I feel better maybe named " Ex Wife Sucs " but

still open to other names. Guess I'd have to change it anyway when

baby learns to read. Besides it does seem a bit mean spirited and

thats not me during normal times. Probably name it " Mali's Boat "

after my daughter. She likes boats in the tub says boat boat.

Yeah in the spring the big rock fish group up around the sunken Ces

bay tunnel which is covered in bolders and when the tide runns they

lay down stream like trout behind a sunken log and chow down. You

catch small fish croakers 6-8 in and use em for bait.

I may not be ready this spring but summer and fall are still a fine

time to cast plugs around the ches bay islands and bottom fish or

troll for blues and rock.

Balt is close by. Once I get settled in this summer maybe we could

fish some and chase geriatric chicks on the beach. It's not a fancy

place some minor crime stealing and that stuff but overall a low

violent crime rate. I kinda like it there and lived across the

street as a child.

Mike

>

> Mike what state and town are you in ,im in not so maryland

baltimore .

>

>

>

[Guest guest]

Mike,

You sound perfectly normal to me. We're the roller coaster crowd. Adrenalin

junkies is what I call it. I love it! No high compares. At least that's how

it works for me. Kinky sex plays in here somewhere, and that's one the docs

would love to include in my diagnosis, but I don't see it as a problem.

<grin>

Anyway, enough of that. I truly am sorry about the problems you've endured

with your wifey. It sucks to be in that sort of situation, loving someone

that doesn't have the ability to participate in a healthy relationship.

I don't think you're a sociopath. Sociopathic personalities are incapable of

empathy. They have no cares for any other human being. I don't think that

applies. Ted Bundy was sociopathic. Someday I'll tell ya my Ted Bundy tale.

Well, its coming up on midnight here, and my neighbors are starting to sound

very strange. Sounds more like Halloween out there, all that wailing and

moaning. Wait! Maybe I should go out there? Get in a little moaning of my

own?

Oh, I found out last week that in the past 8 months my AFP went from 7.2 to

over 19. I know that's not critically high, but it turns out it's the sudden

increase that's the warning. So that's why they got the CT scan. Scan was

clear. I see the GastroVet on Tuesday, and will discuss possible treatment.

Also gotta discuss a colonoscopy. BoyHowdy, that's something I'm really

looking forward to. NOT!

Have a happy New Year, may your coming year be filled with good health, good

mental processes, and prosperity.

Sally <wandering in her dark brain>

Re: Depression and Fatigue:

The HCV

> Connection

>

>

> Sally,

>

> Great research. I wonder how long if ever it takes the brain to

get

> better if the little buggies are removed. Some of the problems

noted

> seemed to fit but I think were worsened rather than created by hep.

>

> Interesting,

>

> Mike

>

[Guest guest]

Hay neet sally ,i did my training to exist in a level 3 bio containment

pathogens lab their , NIH neet place ,the lab i worked in sent me to classes

their .Daughter still in md like i said free tx here if you could move in for a

spell or get here 1 time a month you got it maid so if you got to get a 200

dollar round trip ticket 1 time month its worth it you can alaways stay with me

for a few and i could run you up their its only about 30 mins from me .Tx is

worth 35 to 45 grand and very good doc . eric

[Guest guest]

,

When last husband wanted to shoot me all of us came back to the west coast.

In fact the girls got here first. No, I'll not have money for air fare. My

income will be about 1k a month, and my rent is 570. Not much at all to pay

utilities and live. I'll be staying here in Oregon.

I agree that the medical talents in MD and VA are far better than OR, but

the way I live, I live better here. Thanks for the offer, though. I'll get

treatment here. Now that I've got medical coverage.

Sally

RE: Re: Depression and Fatigue: The HCV

Connection

Hay neet sally ,i did my training to exist in a level 3 bio containment

pathogens lab their , NIH neet place ,the lab i worked in sent me to

classes their .Daughter still in md like i said free tx here if you could

move in for a spell or get here 1 time a month you got it maid so if you

got to get a 200 dollar round trip ticket 1 time month its worth it you can

alaways stay with me for a few and i could run you up their its only about

30 mins from me .Tx is worth 35 to 45 grand and very good doc . eric

[Guest guest]

Hay we are really close a couple hrs i been thinkin about a re locate i do

commerical refig comm kitchen ,heating comm air ,as well as residential, you

know in and outta the fancy bars and restaruants homes ect, pays big money i can

pull in 5 6 7 grand a week once established and it dosent take long they cant

find people to do this and its in demmand everywhere . But nothing too old for

me i got a nice beautiful 44 yr old up here going on tx in about two weeks real

sweet ,im gonna try the old move on her ,i think i have an excellent chance shes

a real sweet heart with a good proffesional skill so like me she can work just

about anywhere and we allready have talked alot just not been out but i will get

close to her when her tx time approaches , she knows i can help her get through

it and of course she is abit scarred since she lives alone . for 44 she does not

look a day over 33 just how i like em slim long red hair a smokeing beatuly, i

could sit their and stare her in the eyes and

wet my pants . all i can say is hot damm .I can wate the yr till tx is done i

might see about bringing her down here or staying with her .

[Guest guest]

Sally,

I used to live in silicon valley, Menlo Park in a small 2br apt. But

huge by local standards like 1000 or 1100 sq ft. What a high stress

place. Just driving to the store is a rat race. Seemed like it

smoged and rained lightly for six months a year.

We'd wait and wait for a sunny afternoon in the nonwinter less rain

season and rush to the beach for a sun tan and it got foogy every

time but once. How I longed for just one sunny day with no cluds or

smog or drizzle for just one whole day.

At that point was pretty sick just thought it was exaustion from the

new baby and lack of sleep but it was the chronic fatigue starting.

I tried surfing there but was too weak and coordination was gone.

Years earlier I was in Silver Spring working for a Defense Company

and had consulting visits to Berkley and used to keep a surf board on

both coasts. I loved the big waves in Cali but my fear of heights

used to freak me out when you drop down on the initial take off. It

was sweet I loved visiting Berkley and soaking up the 60's

influence. Liked all the new foods and laid back vibe.

I surfed from San Fran all the way to Santa Cruz and Baha Mexico.

Liked it so I took a vacation there.

Hope to recover my strength enough to surf again and recover enough

balance and coordination even if I need a big long sloppy old man's

board. It would at least still be surfing of some kind and I am an

old man by surfing standards.

Hope you get a couple sunny hours which is all you ever get in the

nonsummer rainy season.

Mike

> >

> > Mike what state and town are you in ,im in not so maryland

> baltimore .

> >

> >

> >

[Guest guest]

Sally,

Congratulations on the clean skan I was a bit scarred for you. Re

the colonoscopy just think of it as a new kinky sex experience and it

may not be as bad. LMAO

Remember to take your probiotics and eat yogurt cause the prep

removes good bacteria.

Tell us about Ted Bundy. Was he your husband too....

Yes, adrenaline JUNKIE. I used the wrong word but did describe the

condition. Do have empathy.

Actually mostly kid about the kinkly sex. Did have a girly friend

must have had some sort of mild rape fantasy cause she liked to

wrestle and tried to get away after the forplay was all done. She

was a strong straping babe and hard to pin down. Seemed like every

time she was stronger than the last time.

One day I was getting exhaused with wrestling I mean I wasn't sure I

was winning any more and figured enough was enough and reached over

and jerked the phone jack out the wall with the telephone attached

and tied her hands up with the wire and the handset cord and she

loved me ever after.

Could not get her to let me rest after that, let's wrestle Mike, huh

huh, how about it. Sometimes she'd just grab me and start

wrestling. Friendly girl, but sometimes I was tired from the gym and

surfing and just wanted some nice relaxing intimacy without all the

exhausting wrestle mania stuff.

Hey that's a good get rich idea. Televise it and have a regular

show. Today Mike's Wrestling and Sex Mania brings you Yevone the

Russian Minx and Olga the Queen of the Ukrain Amazons in a no holds

barred grudge match. Now that would be TV worth watching.

In the Army they taught me to adapt and improvise in the field and

use what evers handy and all I had was the phone cord. Thank you

Drill Sgt. Wood for my spiritual development!!!

Anyway after that I got some old ties my Dad gave me that no one

would wear I mean realy UGLY and used em for tie up games. That must

have been what Dad intended cause no one would wear ties that ugly...

Thank's for the hint Dad.

Figured some chick like this so it makes for happy chicks. Seemed to

me the chicks either LOVED it or just said yeah that's ok. I liked

it when they loved it cause it was more fun but it didn't do much for

me otherwise.

Mike

> >

> > Hep certainly doesn't help anything. You asked my diagnosis? At

> this time

> > the official is Severe Depression with Suicidal Ideation and ADHD.

> Along

> > with that but not included in the official diagnosis is a type of

> > personality separation. I can be different people. I'm usually

> aware of it,

> > but can't control it. Mostly this was caused by very early trauma

> and being

> > unable to deal with it, but having realized the trauma and coming

> to deal

> > with it, accepting that I *have* survived it, the personality

> splits are

> > melding.

> >

> > And then there's the Shaman thing. I don't consider that a mental

> illness,

> > but some probably would.

> >

> > The paper I copied below is part of a larger body of research that

> speaks to

> > the severe effects of HCV on the nervous system, from the brain

> down to the

> > nerve impulses in the limbs. Its not just a disease of the liver.

> >

> > Sally

> >

> > Re: Depression and Fatigue:

> The HCV

> > Connection

> >

> >

> > Sally,

> >

> > Great research. I wonder how long if ever it takes the brain to

> get

> > better if the little buggies are removed. Some of the problems

> noted

> > seemed to fit but I think were worsened rather than created by

hep.

> >

> > Interesting,

> >

> > Mike

> >

>

>

>

>

>

>

>

>

>

[Guest guest]

,

There are jobs here and you could inde contract. My brother wanted a

hotel refrig mech (he's certified refrig and certified nuts) job.

Said the pay scale sucked here.

Yeha I know what you mean I had a five year live in love with a

sister a few years older than me when I was 33 and she didn't look a

day over 25. I was in love, but back in the day and in DC the bros

didn't always think too highly of me and sometimes when we lived 2

blocks from the projects taking a strol to the corner store was not

all that safe.

Never got beat up but one time she answered back something smart to a

car full of bone thugs who stopped their car in the street to block

our way and for a second I thought the nines are coming out. Being

daytime probably saved my ass.

I was already running as soon as I realized it was a bad place to

be. Perhaps I was a coward to leave her there but figured there was

no way to shut her up once she got started and it was me who was

gonna get popped.

That's not that rare in the area we lived in every other summer

weekend there was a gun fight 2 blocks away and half an hour later

the ambulance would come and the helicopters with spot lights were

always flying over head on summer week end nights.

Could not get her to stop being a smart mouth when people were rude.

She hated rudeness and believed it her duty to bring Wisconson social

graces to the DC area. She was nuts but a real sweet woman she's in

my will.

We moved to silver spring and got along fine there. Mostly I wind up

with the plain vanilla or strawberry flavors but I'm not real picky

if they have a kind heart so choc and coconut are fine with me too.

Mike

>

> Hay we are really close a couple hrs i been thinkin about a re

locate i do commerical refig comm kitchen ,heating comm air ,as well

as residential, you know in and outta the fancy bars and restaruants

homes ect, pays big money i can pull in 5 6 7 grand a week once

established and it dosent take long they cant find people to do this

and its in demmand everywhere . But nothing too old for me i got a

nice beautiful 44 yr old up here going on tx in about two weeks real

sweet ,im gonna try the old move on her ,i think i have an excellent

chance shes a real sweet heart with a good proffesional skill so like

me she can work just about anywhere and we allready have talked alot

just not been out but i will get close to her when her tx time

approaches , she knows i can help her get through it and of course

she is abit scarred since she lives alone . for 44 she does not look

a day over 33 just how i like em slim long red hair a smokeing

beatuly, i could sit their and stare her in the eyes and

> wet my pants . all i can say is hot damm .I can wate the yr till

tx is done i might see about bringing her down here or staying with

her .

>

>

>

[Guest guest]

Mike,

LOL! It's the sun that depresses me. I love the rain. Took me about 6 years

to believe it was really Xmas there without the rain. I know that I'm a very

rare person, even among the natives.

Never spent much time in CA. Oregonians tend to distrust CA and

Californians. Of course we're being overtaken, but we're teaching them

our ways. As we say, " Don't Californicate Oregon " .

I got lost in some research for my girlfriend. And now my head is full of

steel wool.

Be well,

Sally

Re: Depression and Fatigue: The HCV

Connection

Sally,

I used to live in silicon valley, Menlo Park in a small 2br apt. But

huge by local standards like 1000 or 1100 sq ft. What a high stress

place. Just driving to the store is a rat race. Seemed like it

smoged and rained lightly for six months a year.

We'd wait and wait for a sunny afternoon in the nonwinter less rain

season and rush to the beach for a sun tan and it got foogy every

time but once. How I longed for just one sunny day with no cluds or

smog or drizzle for just one whole day.

At that point was pretty sick just thought it was exaustion from the

new baby and lack of sleep but it was the chronic fatigue starting.

I tried surfing there but was too weak and coordination was gone.

Years earlier I was in Silver Spring working for a Defense Company

and had consulting visits to Berkley and used to keep a surf board on

both coasts. I loved the big waves in Cali but my fear of heights

used to freak me out when you drop down on the initial take off. It

was sweet I loved visiting Berkley and soaking up the 60's

influence. Liked all the new foods and laid back vibe.

I surfed from San Fran all the way to Santa Cruz and Baha Mexico.

Liked it so I took a vacation there.

Hope to recover my strength enough to surf again and recover enough

balance and coordination even if I need a big long sloppy old man's

board. It would at least still be surfing of some kind and I am an

old man by surfing standards.

Hope you get a couple sunny hours which is all you ever get in the

nonsummer rainy season.

Mike

> >

> > Mike what state and town are you in ,im in not so maryland

> baltimore .

> >

> >

> >

[Guest guest]

Mike, i was in the country outside balto lately every mothers son and daughter

are here ,changing to burbs and i hate it , they were the good ol days when the

my girl would pull the 410 an start to shoot the squarrls in her garden ,or if i

wasnt lucky me ,seems she would smell my clothes every time i would do some

refig work on baltimores block you know adult entertanimaint section, first i

was puzzeled cause i never did anything then it hit me ,the clothes smelling ,i

gotta laugh now how young and dumb i was not knowing what she was smellin for

,perfume maybe a little pearch or rock ha .eric

[Guest guest]

Mike, i was in the country outside balto lately every mothers son and daughter

are here ,changing to burbs and i hate it , they were the good ol days when the

my girl would pull the 410 an start to shoot the squarrls in her garden ,or if i

wasnt lucky me ,seems she would smell my clothes every time i would do some

refig work on baltimores block you know adult entertanimaint section, first i

was puzzeled cause i never did anything then it hit me ,the clothes smelling ,i

gotta laugh now how young and dumb i was not knowing what she was smellin for

,perfume maybe a little pearch or rock ha .eric

[Guest guest]

Sally ,seems the effects of the head injury were not bad at all it mainly

effects my short term memory and can interfere with concentration , no worse

then tx . But doc said im luckey to be alive with only very mild sides and he

believes they will disapate totally in a yr or 2 . I was blown away by the

people in his office when he said see that one or that one ,same as you but look

at the shape they are in ,it was heart breaking , and this was my 2nd serious

head injury depressed skull fracture was first , pistol whiped from behind on

the job at night. So when doc sees me he grabs all collegues and nurses in

office and says see this guy he s had 2 serious head injuries probably should be

dead if not a cripple and not a thing . Allways says you really do have an angle

on your sholder and goinging into that office and seeing the results of this

kind of injury i beleive it. But then i have alaways been a believer in fate and

Dorris Day ,KAY SA RAH SA RAH what ever will be will be .

[Guest guest]

Clearly you have a generous angel. Keep good care.

Sally

RE: Re: Depression and Fatigue: The HCV

Connection

Sally ,seems the effects of the head injury were not bad at all it mainly

effects my short term memory and can interfere with concentration , no worse

then tx . But doc said im luckey to be alive with only very mild sides and

he believes they will disapate totally in a yr or 2 . I was blown away by

the people in his office when he said see that one or that one ,same as you

but look at the shape they are in ,it was heart breaking , and this was my

2nd serious head injury depressed skull fracture was first , pistol whiped

from behind on the job at night. So when doc sees me he grabs all collegues

and nurses in office and says see this guy he s had 2 serious head injuries

probably should be dead if not a cripple and not a thing . Allways says you

really do have an angle on your sholder and goinging into that office and

seeing the results of this kind of injury i beleive it. But then i have

alaways been a believer in fate and Dorris Day ,KAY SA RAH SA RAH what

ever will be will be .

[Guest guest]

Thanks, Sally

[Guest guest]

Depression and Fatigue: The HCV Connection

Depression and Medication

One of the most significant of the potential adverse effects of interferon and interferon/ribavirin therapy for hepatitis C (HCV) infection is the development or worsening of depression and other psychiatric diseases. In fact, the prescribing information for both pegylated interferons warn that the use of these drugs can result in life-threatening or fatal neuropsychiatric events, including depression, suicidal and homicidal ideation, aggressive behavior and suicide.

We know that the medications used to treat HCV infection can cause disorders of mood and thought. But can HCV infection itself cause mental and emotional problems, even in the absence of medications?

In this article, we will review some clinical studies examining the direct effect of hepatitis C infection on emotional and cognitive function, including depression, impaired mental processing, fatigue, and quality of life.

The Origins of Depression

While depression is a common finding among people infected with HCV, determining the cause of the depression is not simple. There are several possible determinants of depression in the context of HCV infection.

Depression may be a direct physiological result of HCV infection. One study examining a possible biological explanation for anxiety and depression in HCV patients found evidence of mild, but significant neurocognitive impairment in patients with HCV infection. This impairment could not be attributed to substance abuse, coexistent depression or hepatic encephalopathy. The study authors note that the detection of HCV genetic material in brain tissue raises the possibility that HCV infection of the central nervous system may be a cause of psychological symptoms, fatigue and cognitive impairment.

Depression may be a psychological response to the anxiety associated with HCV diagnosis. A study examined the incidence and degree of depression among various groups of HCV patients. Of their study group, about 22 percent had depression and about 15 percent had anxiety. The researchers found that older patients (50 years and older) were significantly more depressed than younger patients. Those advised not to undergo an interferon therapy were also significantly depressed and anxious. Additionally, they found that patients recently diagnosed with HCV infection had significantly lower test scores for depression and anxiety than the group who had been diagnosed more than five years previously, and that recently diagnosed chronic hepatitis C patients also showed the highest levels of problem-solving behavior.

Depression may be a psychological reaction to other physical illnesses associated with HCV. Studies have found a relationship between hepatitis C infection, depression, and fatigue. A study of 50 patients with HCV found that 14 had significant depression, and that the severity of depressive symptoms was associated with functional disability. These authors conclude that disability and fatigue are more closely related to depression severity than to hepatic disease severity, and propose that antidepressant medications for HCV patients C may improve fatigue and functioning.

Another study of depression and fatigue in 115 HCV patients compared levels of fatigue with history of intravenous drug use, alcohol history, transaminase levels and liver biopsy findings.They found that fatigue weakly correlated with the level of fibrosis, but was strongly associated with depression, anxiety, somatization, interpersonal sensitivity and hostility.

Depression may also result from a combination of psychological, emotional and physical factors.

Cognitive Impairment

Studies have demonstrated that some people infected with HCV may have a decreased ability to perform mental tasks.

In one study, a group of 66 patients with chronic hepatitis C and 14 patients with other chronic liver diseases were administered a battery of psychological tests to assess attention, learning, memory, and psychomotor speed. Over 80 percent of the subject group had impairments in attention span and concentration. Researchers found a significant relationship between liver fibrosis stage and test performance, with greater fibrosis associated with poorer performance on tests of cognitve function. This suggests that liver injury may result in cognitive problems even before the development of cirrhosis.

In another study of 21 chronically infected HCV patients, researchers assessed patients subjective cognitive dysfunction, depression, anxiety, and fatigue, and compared these symptom areas to cognitive tests assessing learning, memory, visual attention, psychomotor speed, and mental flexibility.

Results revealed cognitive impairment in 9 to 38 percent of patients. In this group, the degree of cognitive impairment was related to degree of liver fibrosis. Researchers found no relationship between the patient's reports of subjective symptoms, such as depression and anxiety, and the degree of impairment on objective cognitive tasks, such as learning, memory, and attention span. Their findings suggest that a significant portion of HCV patients experience cognitive difficulties that may interfere with the performance of ordinary tasks, thus decreasing quality of life and contributing to anxiety and depression.

Another study examined the cognitive functioning of HCV patients directly through the use of P300 event-related potentials, a sensitive test of the brain's electrical activity. These researchers found that their subjects demonstrated a slight, but significant neurocognitive impairment. These findings were not related to the degree of liver damage, biochemical activity of hepatitis, severity of fatigue or mental health impairment.

Quality of Life

Several studies have examined the relationships between hepatitis C infection and quality of life. These studies typically consider the impact of depression, anxiety, co-existing psychiatric illness and substance abuse as factors affecting the quality of life in HCV patients.

One study evaluated nearly 160 subjects with chronic HCV infection for quality of life using standardized assessment tools. Over 60 percent of the group had cirrhosis. The study authors report that in their group of subjects, a decreased quality of life was associated with more advanced cirrhosis (Child-Pugh class B and C), depression, and a poorer understanding of their disease.

Another study identified that while patients with HCV infection and compensated cirrhosis have a decreased quality of life, decompensated cirrhosis is associated with even greater decreases in quality of life. Diminished quality of life was associated with the severity of liver failure, neuropsychological abnormalities and treatment with beta-blockers or diuretics. The authors note that administration of beta-blocker and diuretic medications in cirrhotic outpatients with prior episodes of decompensation appears to improve quality of life.

An interesting study examined quality of life from a different perspective. These researchers found that people with HCV also experience a decreased quality of life as a result of prejudice and bias on the part of the medical establishment. In this study, 260 patients were interviewed, and 147 study participants reported that they had been stigmatized as a result of their HCV infection.

Women were more likely to report perceived stigmatization than men, and stigmatization was associated with anxiety, depression, decreased quality of life, loss of control and difficulty coping. Study participants also reported problems in their health care and work environment, as well as with family members. The study authors suggest that physicians and other care providers should be aware of the existence and impact of such negative stereotyping.

Conclusions

There is an established relationship between HCV infection, depression and fatigue

There is evidence that depression may be caused by infection of the central nervous system by the hepatitis c virus

Depression strongly correlates with age over 50 years, ineligibility for treatment, and length of time since HCV diagnosis

Depression correlates more highly with fatigue than with physical damage to the liver (fibrosis)

HCV infection appears to directly influence the performance of mental tasks

Impaired cognitive performance contributes to depression and decreased quality of life

HCV infection results in a decreased quality of life caused by depression, fatigue and decreased cognitive performance

Prejudice and stigmatization against HCV patients on the part of the medical establishment contribute to decreased quality of life

Source

PEG-Intron Prescribing Information. Schering Corporation, 2003.

Pegasys Prescribing Information. Hoffmann-La Roche Inc., 2002-2004.

Forton DM, et al. Cerebral dysfunction in chronic hepatitis C infection. J Viral Hepat. 2003 Mar;10(2):81-6.

Kraus MR, et al. Emotional state, coping styles, and somatic variables in patients with chronic hepatitis C. Psychosomatics. 2000 Sep-Oct;41(5):377-84.

Dwight MM, et al. Depression, fatigue, and functional disability in patients with chronic hepatitis C. J Psychosom Res. 2000 Nov;49(5):311-7.

Mc J, et al. Fatigue and psychological disorders in chronic hepatitis C. J Gastroenterol Hepatol. 2002 Feb;17(2):171-6.

Hilsabeck RC, et al. Neuropsychological impairment in patients with chronic hepatitis C. Hepatology. 2002 Feb;35(2):440-6.

Hilsabeck RC, et al. Cognitive functioning and psychiatric symptomatology in patients with chronic hepatitis C. J Int Neuropsychol Soc. 2003 Sep;9(6):847-54.

Kramer L, et al. Subclinical impairment of brain function in chronic hepatitis C infection. J Hepatol. 2002 Sep;37(3):349-54.

Gallegos-Orozco JF, et al. Health-related quality of life and depression in patients with chronic hepatitis C. Arch Med Res. 2003 Mar-Apr;34(2):124-9.

Cordoba J, et al. Quality of life and cognitive function in hepatitis C at different stages of liver disease. J Hepatol. 2003 Aug;39(2):231-8.

Zickmund S, et al. "They treated me like a leper". Stigmatization and the quality of life of patients with hepatitis C. J Gen Intern Med. 2003 Oct;18(10):835-44.

Reviewed October 5, 2005 by V. J. , RN, BSN, MA.

http://www.hepatitisneighborhood.com/content/finding_support/coping_emotional_support_2001.aspx