Liver Disease And Mental Health

What is liver disease?

Did you know that the liver is an organ that is about the same size as a football?

The liver is known to coordinate the chemical levels in the blood and produce bile. This helps facilitate waste products from being removed from the liver.² 

Liver disease may occur due to infections, obesity, misuse of alcohol, and inherited conditions. If liver disease continues to worsen, it can lead to further complications over time.³

Around 90% of liver disease occurs due to alcohol, obesity, and viral hepatitis. This means that the disease is preventable through maintaining a healthy lifestyle. Additionally, the death rate has made liver disease the third biggest cause of premature deaths.⁴

Chronic liver disease can be a burden on mental health

A diagnosis of liver disease can have a large impact on your or your loved ones’ mental health.

Anxiety and depression are common following diagnosis of liver disease, and are characterised by persistent and intense feelings of sadness and worry. 

Research shows that individuals with severe chronic liver disease such as cirrhosis have higher levels of depression and anxiety compared to those with hepatitis, which is inflammation of the liver ⁶  

A contributing factor as to why chronic liver diseases have such a profound impact on mental health is the high rate of morbidity and mortality associated with it. 

Feeling excluded from social events

When diagnosed with a liver disease, some people may be recommended to follow a special diet. Making these changes can reduce the liver’s workload and improve function. The following changes have been shown to potentially improve the symptoms associated with liver disease:

• Reduction in animal protein consumption. This reduction in animal protein limits the buildup of the toxic waste products usually produced by the liver
• Increase carbohydrate:protein ratio in your diet
• High intake of  fruits, vegetables and lean protein, such as legumes, protein and fish (avoiding uncooked shellfish)
• Appropriate supplementation,  prescribed or advised by your healthcare provider. This may include vitamins to help with low blood count, nerve problems, or nutritional problems caused by liver disease
• Monitoring and limiting salt consumption as it may increase fluid buildup and swell the liver⁸

Research shows that lifestyle can have a big impact on your fatty liver index. For example, one study found that 60 percent of individuals who drank alcohol and didn’t exercise were prone to the fatty liver index being affected.⁹ Statistics show that at least 21% of England’s adults drink alcohol at levels that make them more prone to ill health.¹⁰

Lifestyle changes that include limiting alcohol may negatively affect our social life and our mental health as a result. Multiple studies have shown that social rejections can be directly linked to negative effects and lower self esteem.¹¹  

Furthermore, social drinking has been shown to help reduce fears of rejection and increase social bonding.¹² Therefore, a lack of attending social events where drinking is involved could affect an individual mentally due to being excluded for their lifestyle changes while presenting with liver disease.

Can liver disease cause mental problems?

Depression was established in a study to be common in patients with liver disease. Additionally, alcohol use was associated with major depression and suicidal behaviour as well as liver disease. 

However, this study concluded that, while liver diseases was associated with major depression and suicidal attempts, alcohol had no observed contribution to this link.¹³ 

Behavioural outcomes of decreased liver function

Liver failure can cause many complications, including:

• Fluid buildup in the brain (cerebral edema) that can lead to disorientation, severe mental confusion, and seizures
• Acute liver failure can cause internal bleeding
• Infections in the blood and respiratory and urinary tract (UTIs), which can cause anxiety, depression, confusion, aggression, delusions, hallucinations, and paranoia¹⁴ 
• Kidney failure¹⁵

Hepatic encephalopathy

Hepatic encephalopathy is the development of a temporary neurological disorder due to chronic liver disease. Due to the liver being unable to filter out toxins created by the breakdown of food, alcohol, medication, and muscle from the bloodstream, these toxins begin to build up and travel to the brain. The toxicity affecting the brain can cause cognitive impairment.

The symptoms of hepatic encephalopathy consist of:

• Anxiety
• Irritability
• Cognitive impairment (confused thinking)
• Balance problems
• Difficulty concentrating
• Mood or personality changes
• Sleep problems
• Lack of alertness
• Slurred speech

If you’re worried about your or loved one’s mental health

You should seek help if you are concerned about your loved one's mental health. Experiencing mental health problems is completely normal and anyone can be affected by this. There are many free resources available, such as Mind, Every Mind Matters, and Samaritans. Please also contact your GP practice as they will be able to advise you on further specific support to your needs.

Conclusion

Liver disease can affect your mental health. However, liver disease is preventable, so it is important to act before any serious symptoms occur. There are multiple signs that demonstrate that a person can be mentally affected by liver diseases, such as mental confusion, lack of sleep, anxiety, and depression. 

If there is any concern around mental health, it is good to contact your healthcare provider.