hep c and psych issue

[mrkim]

hi 
I am a sixty year old man with hep c and bi-polar disorder mostly manic with psychotic features. Does anybody have this problem. I have not started treatment for the hep c yet but soon. I have had the two issues for 40 years or so. If anyone can give me some advice that would be great.
Thanks Mr. Kim

[jberlin]

Hi Mr Kim,

Could we get a few details. I assume geno 1 since you stated it has been 40 years?  What treatment are you scheduled to start?  Some of these treatments can cause awful emotional swings, so that is one thing to check on, as it could be doubly bad for you.  I strongly suggest a 'buddy' with all these treatments, and in your case I think it mandatory.  Someone close by to help with the schedule and the ups and downs.  My last treatment was the Incivek triple therapy and I would go from an awful temper tantrum to breaking down in tears.  My poor wife was there, endured it, and I very much needed it.  I hope you are on one of the newer, less lengthy, less side effects treatments - but important to find out, and still important to have a buddy.  Best wishes, jack

[mrkim]

Jack
You were right about the genotype, 1a, with a viral load of 6.50. There are also some other numbers that I do not know what they mean. Asp 103, and Alt 166. Can you tell me what these other number mean?
Thanks Mr. Kim

[jberlin]

Those are a blood test of enzymes that indicate liver function or toxicity.  They also look at the ratio of the two.  I am not an MD so I do not want to render an opinion, but your levels are elevated.  You should also have had a total bilirubin test I would guess.  Your best bet is to ask your MD. The best way to give your liver a break and let it heal (the only organ that can) is to get rid of that nasty Hep C virus! -jack

[mrkim]

Jack
The tx is as follows.
1. Pegylated interferon/ Ribavirin Combo Therapy.
2. Triple Therapy with Protease inhibitor: Victrelis (boceprevir), Incivek (telaprevir).
I went and sew my psychiatrist today and she said to do the tx.
Mr. Kim

[jberlin]

OK, Incivek has a better cure rate (slightly) than Victrelis.  I discussed with Hepatologists at Duke and Lifelink prior to starting treatment, and they both said Incivek.  However, you need to be very, very careful.  The 1st 12 weeks, while on the Incivek, is a rigorous schedule, with fat grams like peanut butter, cheese, sausage biscuits... every 8 hours religiously because of the medicine's half life.  YOU MUST HAVE A PARTNER to assist you.  It will cause emotional swings!  Have someone nearby.  If after 4 weeks you don't see a massive drop in your viral count, and are not UD at some point in the 1st 12 weeks you will need to quit.  If you are successful, and over 80% are, then you will remain on the dual therapy for an additional 12 weeks for 24 weeks total.  This treatment still has the highest cure rate I believe, at nearly 95% if UD in 1st 12 weeks and you complete entire regimen. It will go by quickly, but inside the bubble will seem to take forever.  I just counted down the pills and shots, made me feel in control!  Let us know, but you would be much better off with a partner! Or, trying for the more recent meds.  Let us know! -jack 

[lporterrn]

Dear Mr. Kim,
Perhaps you can talk to your doctor about waiting for the Gilead treatment expected to be approved this fall - sofosbuvir and ledipasvir will be combined in a single pill, mild side effects, and 90 - 100% responde rates. Alternatively, if you have advanced disease, some doctors are prescribing sofosbuvir and simeprevir, also high response rates and mid side effects. This regimen is harder to get insurance approval for, but many are on it.
Best thing is to talk to your doctor.

[Mike]

Mr. Kim,

I think Lucinda makes a great point and I would  encourage you to talk to your doctor about various treatment options.
 
The interferon is known to cause severe depression, mood swings and agitation. There is also a noted clinical increase in suicide/suicidal ideation in those who have an active depressive/anxiety disorder prior to treatment.

In fact, if there is active, clinical depression at the time treatment would start, the guidelines say to delay Hep-C treatment (interferon).

The point is, make sure you discuss your entire mental health history, all medications used and current MH treatment needs with the Hep-C doctor. This will help you and the doctor make the best medical decisions for you.

You really need to take your mental health into consideration when starting treatment. The mental health issues associated with Hep-C treatment are clinical noted and can become severe.

There are new Hep-C treatments for genotype 1a that minimize the side effects and reduce the amount of interferon needed. You should talk to your doctor about these.

Best wishes, Mike

[Anand]

Hello Lucinda,

I am curious about the single pill (sovaldi+ledipasovir) by Gilead that is expected to be approved by FDA this fall< I am quoting you>.  Do you have link to Gilead about this combo. Can you elaborate on this combo.  thanks

Anand

[lporterrn]

Here is some info:

[mrkim]

Hi - it's mrkim again - well it's about 4 weeks until treatment starts ( if I agree to it).  I called the Dr office yesterday and spoke to his nurse.  My main reason for  this call was due to the fact that I have many concerns about the psych issues.   

from the printed info I got from the Dr office's list of psych side effects is quite large.  Most of those side effects that are listed, I am very familiar with, many of them I've had.  I talked to the nurse about the new treatment that will be available
early next year.  My Dr was not in that day and she would relay my message.  I am afraid to start the treatment that is now available-but then again I,m afraid not to start. 

Over the past 2 years my psych issues have been controlled with medication.  I saw my psychiatrist last week and she suggests to start the hep c treatment.  Would like to start the treatment to rid myself of hep c, but I clearly remember what it is like to be in the bipolar state!!  When I'm psychotic I see and hear things that aren't really there and it gets worse from there. 

[Mike]

Hi Mr. Kim,

I think if you've been upfront with your doctors and your psych symptoms are under control, you should be fine. The psychiatrist has cleared you and will monitor your mental health while on treatment.

I had some issues with depression the last time I treated, and started on Paxil a week before I started this time. Overall, I've done fine and the depression hasn't really been  an issue.

I would still check in to the 12 week SOL+INTF+RIBV treatment for genotype 1a. It's shorter and you wont be taking the INTF that long. Ideally, if you wait a few months you might be able to avoid the INTF altogether. My rule is the less interferon you take - the better your overall functioning is while on treatment.

Discuss your options with the Hep doctor and see what makes sense for you.

Best wishes, Mike

[lporterrn]

Mr Kim, Your concerns are good ones, which is why I suggested you talk to your doc about the new drugs that are anticipated by the end of the year.