Tides of emotion: How hepatologists can help address mental health in liver disease
By Vinay Jahagirdar, MBBS
As a gastroenterology/hepatology fellow, I've come to realize that liver disease is never just about the liver. It affects every part of a patient's life. What often gets overlooked, though, is the emotional impact. Depression and anxiety are incredibly common in people with chronic liver disease. Studies show that about 16 percent live with depression, and nearly half experience anxiety. These numbers are far higher than what we see in the general population.
Why does this happen? The reasons are both biological and social. Liver disease alters the gut-liver-brain axis, leading to inflammation that can affect how the brain functions. At the same time, many of these patients face difficult life situations, like financial hardship or social isolation. The combination makes emotional resilience harder to maintain.
Mental health struggles are not just side effects. They influence outcomes. Depression has been linked to poor medication adherence, greater fatigue and a lower quality of life. People with cirrhosis who experience anxiety or depression are also at higher risk for opioid use and mortality. These challenges exist across all stages of liver disease, from early fibrosis to acute-on-chronic liver failure.
As physicians, we often focus on what we can measure. We look at MELD scores, bilirubin, albumin. But emotional health does not show up on routine labs, and that makes it easy to miss. Many symptoms overlap. Is the fatigue from liver disease or depression? Is poor sleep a result of hepatic encephalopathy or anxiety? These blurred lines make diagnosis and treatment more complex.
Despite the challenges, hepatologists are in a strong position to help. We see patients regularly. We build relationships. This gives us a unique opportunity to screen for and address mood disorders early. Several tools can help, such as the Hospital Anxiety and Depression Scale or the PHQ-9. These are simple and effective ways to start the conversation.
Treatment options exist. Cognitive behavioural therapy and mindfulness techniques can be helpful. Some patients benefit from structured programs, even via mobile apps. Physical activity, tailored to the patient's condition, can also lift mood. Yoga, walking and even basic stretching have shown benefits.
When medications are needed, selective serotonin reuptake inhibitors are generally safe for people with liver disease. These are often well-tolerated and have fewer interactions. On the other hand, drugs like benzodiazepines should be avoided due to the risk of worsening hepatic encephalopathy.
We must also support the people who care for our patients. Caregivers often experience stress, burnout and guilt. Including them in the care process and offering support resources can make a big difference for everyone involved.
Mental health in liver disease is not a niche issue. It is central to how our patients experience their illness. If we want to improve quality of life and outcomes, we have to treat the whole person. That includes their emotional health.
Let's not miss that chance.
Vinay Jahagirdar, MBBS, is a second-year GI-Hep fellow at Virginia Commonwealth University. He is a co-author of “Tides of emotion: Hepatologists’ role in navigating depression and anxiety in liver disease,” published by Hepatology Communications, on which this is based.