Depression is common among people with chronic liver disease, and can make the condition worse, according to a recent review in The American Journal of the Medical Sciences.
Chronic liver disease includes conditions such as primary biliary cholangitis (PBC), metabolic dysfunction-associated steatotic liver disease (MASLD), viral hepatitis, autoimmune hepatitis (AIH), primary sclerosing cholangitis (PSC), hemochromatosis and Wilson’s disease.
The review found that depression can have a major impact on health outcomes, quality of life and survival in people with liver disease. One reason is that people with depression are often less likely to take medications as prescribed or maintain healthy habits, which can cause their liver disease to worsen more quickly. Depression is also linked with behaviors such as alcohol misuse and poor nutrition, both of which can directly harm the liver and speed up disease progression.
There are also biological reasons for this connection. Depression triggers inflammation throughout the body, which can lead to liver scarring (fibrosis) and further liver damage. It can also weaken the immune system, making patients more vulnerable to infections and complications after a liver transplant.
“The bidirectional relationship between depression and liver disease is especially concerning, as mental health issues can exacerbate liver conditions, and liver disease can, in turn, worsen mental health, creating a challenging cycle to break,” the review’s authors said.
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The review also explored how antidepressant medications might play a role beyond improving mood. Some drugs, especially selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs), may have beneficial effects on liver health by reducing inflammation and liver scarring. “However, the current research on the effects of antidepressants on liver disease progression remains limited, requiring further exploration,” the authors said.
The authors recommended that depression should be carefully screened and managed in people with liver disease, ideally through collaboration between liver specialists and mental health providers.
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