Depression and Anxiety in End-Stage Liver Disease

Disclaimer: If you or someone you know is experiencing thoughts of suicide, call the United States National Suicide Prevention Lifeline at 1-800-273-8255. 

End-stage liver disease is a potentially serious consequence of hepatitis C. End-stage liver disease is not the same as cirrhosis; rather, it signifies a stage where the liver has failed. This condition is considered irreversible and a liver transplant is typically the only available treatment.

The link between depression, anxiety, and end-stage liver disease

There are various reasons to explain why people with end-stage liver disease may have higher occurrences of depression and anxiety. One of these reasons is that not everyone with end-stage liver disease is a suitable candidate for a liver transplant.¹

Another reason is associated with the significant anxiety one may face when waiting for the transplant; about 14% of people waiting for a liver transplant die every year in the United States.¹ This is ultimately because there are more people waiting for a transplant than there are available organs.² Furthermore, life after transplant may be overwhelming, with concerns of infection and adverse effects of medications that reduce the risk of organ rejection.³

Prevalence of depression and anxiety

With the prognosis variability of end-stage liver disease, it is natural to feel depressed and/or anxious. There are not many studies that highlight the occurrence of depression and anxiety in this population, but one study examining people with cirrhosis revealed that greater than 50% of them had symptoms indicative of depression.⁴

Another study showed there are additional factors that reduce the quality of life in people with cirrhosis, such as fatigue, which may contribute to depression.⁵

Diagnosis in end-stage liver disease

Unfortunately, depression and anxiety in end-stage illnesses are usually under-diagnosed, and therefore, not always treated.⁶ That is because grief is an appropriate reaction to a condition that may potentially take one’s life. While this is a normal response, there are some feelings that correlate more with depression. Examples of these feelings include:

• Feeling worthless or guilty
• Lack of pleasure in activities once enjoyed
• Thoughts of suicide⁶

Knowing when to get help

If you are experiencing end-stage liver disease and feel depressed and/or anxious, I recommend speaking to your clinician. This could be your primary care doctor or your specialist (gastroenterologist or hepatologist). If you are waiting for a transplant, perhaps it could be a psychologist on your transplant team. It can be hard to get help when you feel hopeless. Sometimes, bringing a close friend with you to the appointment can help.

There are various treatment options for depression and anxiety. These may include counseling services, cognitive-behavioral therapy (CBT), electroconvulsive therapy, and medications.⁷ Your doctor will help find the most appropriate treatment based on your comfort level or may refer you to a qualified psychiatrist.

Major depression in people with advanced liver disease is considered treatable.⁷ You do not have to endure the pain.

Have you been treated for depression/anxiety during your hepatitis C journey? Share your experiences below.