The Centers for Disease Control and Prevention (CDC) estimates that approximately four million people suffer from hepatitis C in America—a disease of the liver. But living with the virus can affect more than just the liver. It can negatively impact a person’s state of mind, as well. This is especially true for the 234,000 veterans living with this condition—approximately 50,000 who are believed to carry the virus without knowing it. Considered the A Doctor Holding a Hepatitis C Signleading cause of cirrhosis, liver cancer, and U.S. liver transplants, hepatitis C is caused by the hepatitis C virus (HVC)—an infection that causes the liver to scar, swell, and often fail.

Managing the physical symptoms of this chronic disease is often challenging; but, there are also mental health issues that can develop in people with hepatitis C. Veterans infected with this virus have a high rate of mental health conditions, including depression. According to the United States Department of Veterans Affairs (VA), approximately 56 percent of veterans who were diagnosed with chronic HCV were also diagnosed with depression in 2008. Addressing psychiatric issues is especially critical when veterans, who show signs of depression, are treated with interferon-based therapies or are being evaluated to receive a new liver.

Some people who contract hepatitis C go on to live a normal life for many years. Others, however, live with painful and serious symptoms that impede their ability to perform full-time work. If a veteran’s hepatitis C reaches this point, he can apply for VA Disability benefits under Code 7354 in the VA Schedule of Ratings, or possibly under Code 9434 if his disease has caused depression. Filing for disability can often be frustrating and time-consuming, and veterans may want to consider obtaining the help of a disability lawyer.

The Connection Between Hepatitis C and Depression

Many people don’t understand the causes of hepatitis C or know much about the condition, and this has caused an inaccurate and often damaging stigma about the disease. People who are diagnosed with hepatitis C sometimes feel that others are judging them or want to avoid to avoid them, and this can lead to withdrawal and depression. Assistant professor of medicine at Harvard Medical School in Boston, Camilla Graham, MD, says, “People with hepatitis C may become isolated, which can pave the way toward depression.” Additionally, research reported in the Hepatitis Monthly journal in 2013 states that people with the virus are “more likely than others to report problems with physical functioning, general health, and vitality.”  

Understanding Depression

A person is considered depressed if he’s unable to feel pleasure from normal, daily events such as social or sexual interaction, eating, or exercise—and this lasts for at least two weeks. This depressed mood must be accompanied by at least four of the following:

  • Recurring thoughts of suicide or death

  • Feeling overwhelmed and paralyzed by a sense of emptiness or sadness

  • Feeling worthless or filled with guilt

  • Lacking interest in daily activities or engaging in a normal routine

  • Presenting changes in weight and appetite

  • Showing signs of disrupted sleep patterns

  • Showing changes in psychomotor activity

  • Showing a loss of energy and extreme fatigue

  • Showing difficulty focusing, making decisions, or concentrating

Factors Linking Depression and Hepatitis C

Doctors and researchers believe that there are four possible “mechanisms” that connect chronic HCV with depression. Here is a brief look at factors that may contribute to the causative relationship between the two:

  • The psychological effect of a hepatitis C diagnosis. Many health experts believe that hepatitis C produces stress and a psychological burden because the symptoms associated with the condition can reduce quality of life. When people suffering from the condition experience on-going physical symptoms that diminish the way they live and function, it can be a catalyst for depression.

  • A pre-existing condition. Some studies suggest that if a person suffers from depression, post-traumatic stress disorder, or some other psychiatric disorder, it can lead to high-risk behaviors, including drug use through needles or engaging in unprotected sex. While HCV is not considered to be the cause for depression, there appears to be a higher occurrence of depression in those who participate in dangerous practices.

  • A biological result. Some studies show that there’s a potential for hepatitis C to negatively impact the body’s central nervous system, and this can bring on depression. Although a direct correlation has not been proven, hepatitis C viral particles, known to cause chemical changes that can initiate depressive symptoms, have been found in the central nervous system.

  • A psychological perspective. According to best-selling author and motivational speaker, Esther Hicks, when people experience positive, good feelings, those feelings are “likened to the perception of freedom.” When people experience bad feelings, those feelings are “likened to the perception of bondage.” And it’s this feeling of bondage or lack of freedom or control over one’s life that underscores some of the feelings associated with depression. Many people suffering from hepatitis C feel that their condition and the ability to recover are out of their control. Consequently, depression can occur because:

  • A person is told that his hepatitis C is incurable.

  • A person doubts that he’ll ever be able to rid himself of the disease.

  • A person experiences severe side effects from treatment that make him feel his condition is getting worse. This continues to feed a feeling of loss of control.

Hepatitis C Treatment Can Cause Depression

Over one-third of hepatitis C sufferers experience some level of depression, but many say that when they receive treatment and are cured of the disease, they no longer feel depressed. However, that’s part of the problem. Not only does the disease itself have the potential to cause depression, some medication used to treat hepatitis C has been known to cause depression, as well. The two most commonly used medications, often taken together, for hepatitis C, are:

  • Pegylated interferon. This medication encourages a body’s immune system to attack the HCV virus.

  • Ribavirin. This is an antiviral medication that halts the reproduction of the virus.

Unfortunately, Ribavirin has been known to cause mood swings in patients, including depression. But in 2011, two non-interferon-based therapies called direct-acting antivirals (DAAs)—boceprevir and telaprevir—were approved to treat hepatitis C that lower the risk of depression in patients. It’s important that if your doctor plans to treat your hepatitis C with interferon, you tell him about any history you may have of depression or other mental illnesses.

We Can Help

If you’re a veteran who suffers from debilitating hepatitis C, and you can no longer enjoy or participate in everyday activities or sustain gainful employment, call Cuddigan Law at (402) 933-5405. We understand that you may need VA Disability benefits and we can step you through the process. Whether you need to fill out an application or your current claim was denied, we’ll schedule an initial evaluation to discuss your specific case.


Sean D. Cuddigan
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SSA and VA Disability Attorney in Omaha, Nebraska