Mental Health

Key messages

• Liver disease and mental health are connected
• People with liver disease can have worse mental health
• People with mental health challenges may not be focussed on their liver health
• Taking care of your mental health can improve your liver health
• There are lots of treatments available
• Don’t be afraid to ask for help

The liver and mental health

The body and mind are closely connected. When your body is sick, your mind can get sick too.

Research shows that people with liver disease are more likely to experience a mental health condition.

It’s important to treat mental health conditions for your liver health. That’s because looking after your mental health will make you feel more motivated to look after your liver. Good mental health will help you follow a healthy lifestyle and stick to your treatment plan.

How does liver disease affect the brain?

Your brain can be affected when the liver doesn’t work properly. For example, if your liver doesn’t process alcohol or medicines, toxins (poisons) can build up in the body. These affect the brain as well as other organs.

The liver stores energy that it releases into the blood as glucose (sugar). The brain needs enough glucose to work properly.

The liver also looks after vitamins, minerals and chemicals in your blood, which can all affect your brain.

Mental health conditions and liver disease

Some mental health conditions are more likely in people with liver disease.

The relationship between many liver diseases and mental health problems may be two-way. For example, people with fatty liver disease related to obesity or unhealthy alcohol use may experience depression and anxiety, and people with depression and anxiety or long-term stress may have an increased risk for obesity and unhealthy alcohol use.

Depression and anxiety

Depression and anxiety are 3 times more common in people who have liver disease.

We don’t know why, but it could be because people with liver disease often feel very tired, or they may not be able to work or socialise as they used to.

Some signs you may have depression include:

• Being sad or weepy
• Feeling overwhelmed
• Feeling angry or restless
• Feeling hopeless
• Having negative thoughts
• Not enjoying things you used to enjoy
• Not being able to feel joy
• Withdrawing from friends and family
• Sleep problems
• Changes in appetite
• Thinking of hurting yourself

Some signs you may have anxiety include:

• Panic attacks (feeling very afraid)
• Racing heart
• Shortness of breath
• Dizziness
• Problems sleeping
• Trembling
• Sweating

Talk to your doctor if you have these symptoms for 2 weeks or more.

Symptoms like changes in appetite, feeling very tired, sleep changes and problems concentrating could all be due to your liver disease.

But if it’s depression or anxiety, medicines and other treatments can make a huge difference.

Trauma

Some people who experience trauma like a life-threatening event develop post-traumatic stress disorder (PTSD). It is possible to get PTSD if you have been very ill in hospital or had surgery.

PTSD is more common in people who have:

• Viral hepatitis
• Alcohol-related liver disease
• Fatty liver disease
• Treatment in intensive care for complications of liver disease

Some signs of PTSD include:

• Re-experiencing the trauma through dreams or flashbacks
• Nightmares
• Triggers like smells or sounds bring back the trauma
• Avoiding going to places that remind them of the trauma
• Feeling down and helpless
• Not being able to feel joy
• Being constantly alert – in ‘fight or flight’
• Being irritable or aggressive
• Sleeping problems
• Difficulty concentrating

People with PTSD have too high levels of stress hormones in their body. This can affect organs including the brain and liver.

People with PTSD can also develop depression, sleep badly and find it hard to concentrate. They may also drink unhealthy amounts of alcohol, eat an unhealthy diet or use substances that can affect the liver. This can all affect how well they look after their liver health. They may also find it harder to ask for help.

PTSD symptoms can be treated with medicines and therapy.

Cognition

Cognition means your memory, attention, concentration, and how you plan and do tasks.

Your liver health directly affects your cognition. This is because toxins in your body can build up and change the chemistry in your brain. Your brain doesn’t work as it should.

Signs your cognition is affected include:

• Forgetfulness
• Trouble concentrating
• Confusion
• Changed behaviour

These problems can all be caused by dementia, depression, psychosis, or attention deficit hyperactivity disorder (ADHD).

Similar symptoms may occur in people with severe liver disease. When they’re caused by problems with liver function, it’s called hepatic encephalopathy (HE). HE is a problem with the nervous system caused by severe liver disease. It is treated by removing toxins from the body with medicines like antibiotics or laxatives. It is usually temporary (short lasting), but it can come back.

In general, you can help look after your cognition by eating a balanced diet, exercising, getting enough sleep, and staying clear of drugs and alcohol.

If you have liver disease, looking after your liver and taking your medicines as instructed by your doctor is very important to protect your cognition.

It is important that you and your loved ones learn how to recognise if your cognition is impaired so that you can access appropriate medical care.

Insomnia

Insomnia means having problems falling asleep or staying asleep.

We need enough sleep for good mental health. If you don’t get enough sleep, you can be at higher risk of anxiety, depression and concentration problems.

Some people with liver disease find it harder to sleep. It can be a sign you’re developing hepatic encephalopathy.

It’s important to try to fix your sleep.

• Go to bed and get up at regular times
• Relax before you go to bed
• Make sure your bedroom is comfortable and not too hot or cold
• Avoid screens just before you go to sleep
• Avoid things that can disturb your sleep, like alcohol, drugs and cigarettes
• Avoid sleeping pills. They won’t help long-term and may increase the risk for hepatic encephalopathy in people with severe liver disease

Talk to your doctor if you’re finding it hard to sleep. There is treatment available.

Substance abuse

Substance abuse disorders are when people take too much alcohol or drugs. These problems are common in people with liver disease.

People with chronic liver disease are more likely to inject drugs, take marijuana and stimulants and use alcohol at harmful levels.

People with liver disease who carry on using alcohol are more likely to have other mental health symptoms too. And people with a mental health condition are more likely to use alcohol or drugs to try to feel better.

Don’t be ashamed to talk to your doctor if you have a problem with drugs or alcohol. Getting it sorted will help your mental and physical health as well as the health of your liver.

Stigma

Stigma is when someone thinks or talks about you in a way that’s unfair.

People with liver disease can experience stigma. People might blame them for developing their condition. They might be accused of bringing it on themselves by drinking too much alcohol, injecting drugs or not being a healthy weight.

Remember – millions of people have these issues. You have a right to treatment. You have a right to be treated fairly and to not be discriminated against.

Make sure you look after yourself. You are worth it.

Don’t ever let what others think stop you from seeking treatment and protecting the health of your liver.

How are mental health conditions treated?

If you have a mental health condition, getting it sorted will also help your general health.

The first step is to see your GP. They can link you to professional help if you need it.

Treatment will probably involve medicines combined with therapy to help you think differently about things.

Make sure you take your medicines as instructed. They can take a few weeks to start working properly. Don’t stop your medicines if you think they’re not working – always talk to your doctor first.

If you have very bad mental health problems, your doctor may suggest electroconvulsive therapy.

What can I do to improve my mental health?

Here are some tips that anyone can do to protect their mental health.

• Notice what makes you upset or angry and try to make changes to avoid these feelings
• Express your feelings – but not in a way that could hurt others
• Think before you act. Cool down and remain calm
• Cope with stress – breathe deeply, do some exercise, try yoga or meditation
• Do things you enjoy – make time for things you really like to do and that give you a sense of purpose
• Connect with family and friends
• Take care of your physical health to improve your mental health, such as by eating healthy meals and getting enough sleep
• Avoid alcohol and drugs. They’ll make things worse
• Try to stay positive. Stop putting yourself down

Getting support

You don’t have to do this alone. There is support available

Reviewed November 2022