Is depression harmful to the liver?

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Is depression harmful to the liver? One cannot answer that question with a “yes” unambiguously. But there is a lot of evidence that suggests that could be the case. This is because although chronic liver disease has long been recognized and associated with depression, the underlying mechanisms of this association remain unclear and further research should investigate the bidirectional relationship between them.

Association between Chronic Liver Disease and Depression

Depression, also termed as major depressive disorder or clinical depression, is a mental illness characterized by persistent low mood, accompanied by low self-esteem and a loss of interest in once pleasurable activities. Clinical studies have shown that some patients with chronic liver disease (CLD) have more severe depressive tendencies than healthy ones. In one cross-sectional study, it was found that in 62.9% of patients with chronic liver disease, depression was present. However, the underlying mechanisms of this association remain largely unknown (Huang, et al., 2017).

Depression and Chronic Hepatitis B

A 1985 study found that out of 40 British Hepatitis B virus (HBV) carriers, 34 patients experienced depression, 22 felt isolated, 15 felt guilty, and 3 had sought and 4 had considered seeking psychiatric help. Furthermore, in a 2000 study done on 40 Korean healthy HBV carriers, 46% of them (23 patients) reported symptoms of depression. A 2005 study showed that HBV carriers were more likely to have psychiatric disorders than comparison subjects (30.2% vs. 11.6%) (Huang, et al., 2017).

Depression and Chronic Hepatitis C

Evidence from a 2000 study suggests that psychiatric problems, particularly depression, frequently occur in chronic hepatitis C (CHC) and during antiviral treatment. The presence of depression symptoms in CHC leads to an adverse effect on the course of illness, with worsening of symptoms, functional impairment, and decreased compliance of treatment and quality of life. Several other studies, including a 2013 study, showed that depression was strongly associated with CHC (Huang, et al., 2017).

Depression and Alcoholic Liver Disease

Some studies concluded that alcohol use may lead to depression symptoms as well as an increased risk of parasuicide and suicide. But, others have found that depression may increase alcohol use. Several other studies showed that alcoholic liver disease (ALD) was associated with depressive symptoms, particularly in the elderly. In a cohort of patients with ALD including both cirrhotic and noncirrhotic, a 1983 study showed that 40% of patients had psychiatric disorders, but no direct correlation was established between the degree of ALD and the likelihood of depression (Huang, et al., 2017).

While the relationship of depression with CLD is complicated, shared biological mechanisms might underlie the association between depression and CLD in some individuals. Overall, these findings indicate that the protein complexes that activate inflammation (NLRP3 inflammasome) in response to danger signals are also involved in the pathogenesis of depression and CLD, so understanding its role in both diseases may build a linkage between them (Huang, et al., 2017).

The 2015 University of Edinburgh Study Linking Depression and Liver Disease

The 2015 University of Edinburgh study, done over a 10-year period, investigated psychological distress in more than 165,000 people. They then tracked participants’ progress, examining who died and the causes of death. Individuals who scored highly for symptoms of psychological distress were more likely to later die from liver disease than those with lower scores. The study accounted for factors such as alcohol consumption, obesity, diabetes, and socioeconomic status (ScienceDaily, 2015). The work did not uncover any reasons for direct cause and effect (Sung, 2015).

Antidepressants Harm the Liver

All antidepressant drugs may potentially cause liver injury, even at recommended doses, and some groups are more vulnerable than others. A 2013 French meta-review found that 0.5% to 3% of patients treated with antidepressants may develop asymptomatic mild elevation of serum alanine aminotransferase (ALT) levels. Liver damage may occur between several days and 6 months after the initiation of an antidepressant. The antidepressants with highest risk for liver damage are MAO inhibitors, tricyclic  antidepressants, nefazodone, burpoion, duloxetine, and agomelatine. Those with seemingly lower risks are citaloparm, escitalopram, paroxetine, and fluvoxamine. Although no dose-response relationship has been demonstrated, it is best to stick to the minimum effective dosages of antidepressants to reduce the risk for liver injury (Brooks, 2013).

References

Brooks, M., 2013. Antidepressant-Induced Liver Injury Underestimated. [Online]
Available at: https://www.medscape.com/viewarticle/818512
[Accessed 17 Sep 2019].

Huang, X., Liu, X. & Yu, Y., 2017. Depression and Chronic Liver Diseases: Are There Shared Underlying Mechanisms?. [Online]
Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5420567/
[Accessed 17 Sep 2019].

ScienceDaily, 2015. Stress levels linked to risk of liver disease death, study shows. [Online]
Available at: https://www.sciencedaily.com/releases/2015/05/150519105856.htm
[Accessed 17 Sep 2019].

Sung, D., 2015. Depression and stress linked to liver disease. [Online]
Available at: https://www.independent.co.uk/news/science/depression-and-stress-linked-to-liver-disease-10262684.html
[Accessed 17 Sep 2019].

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Is depression harmful to the liver?
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Is depression harmful to the liver?
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Is depression harmful to the liver? A lot of evidence suggests this to be the case. Liver disease has long been recognized as associated with depression.
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DepressionPedia.org
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