When you found out that you had metabolic dysfunction-associated fatty liver disease (MAFLD) formerly known as non-alcoholic fatty liver disease, you might have gotten a lot of information about its physical effects on your liver and on the rest of your body. But liver disease can take a toll on your mental and emotional health, too.
If you’ve been feeling down since your diagnosis, know that about 1 in 5 people with metabolic dysfunction-associated steatohepatitis (MASH), the most serious form of MAFLD, have depression. But that doesn’t mean you should just live with it. There are effective treatments for stress, anxiety, and depression related to chronic illness. If you don’t do anything to help your emotional health, your liver disease could become harder to get under control.
Here’s a look at how liver disease affects mental health and how you can get relief.
How Does Chronic Disease Affect Mental Health?
MASLD and MASH are chronic diseases. Once you have a chronic disease, you’ll most likely have to manage and live with it for the rest of your life. To do this successfully, it’ll take potentially difficult lifestyle changes and possibly medication and surgery. In short, chronic liver disease is life changing, so it’s not unusual to feel overwhelmed, stressed, anxious, or even depressed about your diagnosis.
In addition to stress and depression, liver disease can also affect your brain by messing with functions like toxin filtration, gut health, blood sugar control, and nutrient delivery. All of these can lead to mood changes and cognitive problems.
People who have chronic diseases are more likely to develop depression than the general population.
Depression in chronic disease can be a result of:
- Ongoing anxiety, stress, or challenges brought on by the diagnosis
- Ongoing anxiety, stress, or challenges brought on by the required treatment and necessary lifestyle changes
- Physical brain changes that some chronic diseases, including liver disease, can cause
- Side effects of medications used to treat the chronic disease
How Does Liver Disease Affect Mental Health?
Living with liver disease, you may notice many of the challenges that people with any chronic disease face. Like others with a chronic condition, you’re facing uncharted territory full of new obstacles.
But the specific reality of liver disease, which doesn’t necessarily mirror that of other chronic illnesses, can hit you pretty hard, too. Unmanaged liver disease can get worse and even lead to the need for a liver transplant. It’s common to feel fear about your future, the risk that your disease will progress, and the chance that you may need a liver transplant.
Does the Liver Have Direct Effects on Mental Health?
Not only can a liver disease diagnosis lead to stress, anxiety, and depression, but liver disease itself can also cause brain changes that impact your mood and emotional well-being. In addition to stress and depression, liver disease can also affect your brain by messing with functions like toxin filtration, gut health, blood sugar control, and nutrient delivery. All of these can lead to mood changes and cognitive problems.
What does the liver do?
Your liver has many jobs that are very important to the function of your other organs, including your brain.
Your liver:
- Filters toxic substances from your blood that the body produces naturally or that you take in through alcohol, drugs, or medications
- Manages blood clotting
- Produces an acid called bile that helps digest fat and regulates the healthy balance of gut bacteria
- Stores sugar by turning it into glycogen so that it can be used for energy later
- Makes the protein that blood plasma uses to transport hormones, nutrients, and other substances to wherever they’re needed throughout the body
- Helps with digestion
How does liver failure affect mental health?
If liver disease progresses to the point that your liver can no longer carry out its many important jobs, it can have negative effects on your brain and, in turn, your mental health.
Toxins and your mood. If your liver can’t filter toxins out of your bloodstream, those toxins can build up and reach other organs, including your brain. Not only might toxins in your brain cause cognitive (thinking) problems, but they could cause changes in your thoughts, mood, and behavior, too.
Your gut and your mood. The liver’s role in regulating gut bacteria may play a big part in keeping your mental health stable. If your liver can’t carry out its duties in the management of gut bacteria, the whole gut microbiome can get thrown off-balance. That’s called gut dysbiosis, and it means that you’ve got more bad bacteria than good or that you’ve got too much of the same thing and not enough diversity. This gut bacteria imbalance is often seen in people with liver disease, and a growing body of evidence links gut dysbiosis to a higher risk for depression.
Blood sugar and your mood. Your liver plays a critical role in blood sugar control. When your blood sugar is out of control, insulin resistance and in turn, diabetes, can develop. Research is still looking into the relationship between diabetes and depression, but this much is known: Among people who have liver disease, those who also have diabetes are more likely than those without it to have depression, too. Researchers don’t believe that it’s simply that having diabetes is depressing. Ongoing research is exploring a so-called “bidirectional” (flowing both ways) relationship between the two conditions. That is, the idea that diabetes could raise the risk for or worsen depression, and depression could raise the risk for or worsen diabetes.
Nutrients and your mood. Your liver makes proteins that your blood plasma – the liquid part of your blood – uses to move hormones and nutrients to wherever they’re needed throughout your body. If your liver stops making these proteins, your brain won’t get the nutrients it needs.
Research has shown that both a lack of nutrition and low blood plasma protein levels can lead to depression.
Inflammation and your mood. MASLD and MASH are inflammatory diseases. They’re caused by inflammatory metabolic dysfunction, and they cause inflammation in the liver. In short, they’re part of an intense cycle of inflammation.
Inflammation can trigger processes in the brain and the gut that can lead to the development or worsening of depression.
Can Depression Worsen Liver Disease?
Depression doesn’t just take a toll on your mental health. It can do a number on your physical health, too – especially when you’re living with a chronic disease like liver disease.
In a study of nearly 250,000 adults from 60 countries, researchers found that those who were living with depression and a chronic disease had worse health than those living with two chronic diseases but no depression or those living with depression only.
There’s evidence that depression and your immune system function have an effect on each other. Some studies have shown that the mood disorder can weaken your immune system and prevent it from doing its job of fighting sickness and disease. Others suggest that an immune system dysfunction can lead to depression.
Either way, a body under the stress of depression may not be as good at fighting disease as a body that is not under this stress.
Being depressed can also make it harder for you to take good care of yourself – which is even more important when you’re living with a chronic disease.
When you’re depressed, you may not feel like sticking to your recommended exercise program. You may want to reach for high-calorie comfort foods rather than the ones that could help turn your disease around. You might not feel motivated to take your prescribed medications. Depression can also cause trouble sleeping. Ongoing poor sleep can mess with immune function. All of these effects of depression can make your condition worse.
Research shows that depression in people who’ve had an organ transplant can raise the risk that the person rejects the organ (which means their body doesn’t react well to the new organ) or doesn’t stay on top of the necessary post-transplant medication and follow-up appointments.
How Can You Tell If You’re Depressed?
It’s normal to feel some stress and anxiety related to your new normal after a liver disease diagnosis. But if your low mood doesn’t improve and gets in the way of your daily life, your self-care, or your sleep, it might be more than stress and anxiety. You could have depression.
Do any of these symptoms seem familiar to you?
- Feeling sad, tearful, empty, or hopeless
- Angry outbursts, irritability, or frustration
- Loss of interest or pleasure in your normal activities or things you typically enjoy
- Changes in sleep, whether having trouble sleeping or sleeping too much
- Low energy or extreme tiredness, making small tasks require big effort
- Loss of appetite and weight loss, or cravings and weight gain
- Slowed thinking, speech, or movement
- Feeling worthless, guilty, or focused on past failures
- Brain fog, loss of concentration, forgetfulness, trouble making decisions
- Unexplained pain, like back aches or headaches
What Should You Do About Depression?
Just because depression is more common in people with chronic disease doesn’t mean you should “stick it out.” The combination of chronic disease and depression can be a recipe for more severe disease. There are effective lifestyle changes and treatments for depression.
First, there are things you can do to manage disease-related stress and anxiety so that they’re less likely to lead to depression.
- Get at least 7 hours of sleep every night.
- Explore stress-relieving activities, such as mediation, deep breathing, and yoga.
- Get as much exercise as possible, as it’s a known stress reliever.
- Focus on “me” time and find a hobby you enjoy like reading, listening to music, or relaxing.
- Prioritize your social life and stay connected with friends.
- Lean on family and friends and ask for help when you need it.
- Take a look at your weekly routine and get rid of any sources of stress that aren’t necessary.
- Join a support group for people with liver disease or chronic disease.
- Avoid negative stress relievers, such as drinking, smoking, or over-eating unhealthy foods.
If these tactics don’t seem to help, or if stress, anxiety, and depression are getting in the way of daily life, talk to your doctor. You don’t need to be ashamed to mention your mood to your doctor. Depression is a health condition that can and should be treated – just as your liver disease should be treated.
When you tell your doctor about your mood, they might:
- Ask questions to get more specific details about your symptoms
- Ask what medications you take in case depression is a possible side effect
- Do a physical exam or order blood tests to rule out other health conditions that may cause your symptoms
Your doctor may recommend:
- Talk therapy. This approach can help you change the way you think about your situation and adopt new ways of responding to it.
- Antidepressant medications. It can take a few weeks to start to feel relief, and you might have to try a few before you find the one that works best.
- A combination of both medicine and talk therapy to get the best possible results.
If you have thought about or tried to hurt yourself or you’re having a mental health crisis, don’t wait for your next doctor’s appointment. Get help right away in an emergency room or a crisis hotline.
To reach the 988 Lifeline, a national suicide and mental health crisis hotline:
- Call or text 988
- Chat online at 988lifeline.org
The hotline is also available to those with any level of hearing loss via video phone or online.
Recap
- MASLD can affect your mental and emotional well-being in addition to your physical health.
- Many people with liver disease, especially those with MASH, develop depression due to the stress of managing a chronic illness, medication side effects, and lifestyle changes.
- Liver disease can also directly impact your mental health by causing brain changes and affecting things like gut bacteria and blood sugar, which are linked to mood and cognitive problems.
- It's important to seek treatment. Untreated depression can worsen both your mental and physical health.
Show Sources
Photo Credit: Valentinrussanov/Getty Images
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