April 27, 2021

A Psychiatrist’s Advice for Managing Chronic Liver Illness

woman holding drawing of sad liver

By Shivani Chinnappan, SWHR Programs Coordinator

Managing a chronic illness involves more than just finding medication to control symptoms in a way that allows a patient to live a relatively “normal” life. People living with chronic illness are at higher risk for developing mental health conditions like depression, and women are diagnosed with depression almost twice as often as men. Psychological care can have an immense impact on the quality of life for patients with chronic health issues, according to Dr. Jennifer Pate, a psychiatrist who works with patients with chronic liver conditions.

Pate discovered her passion for treating patients with chronic illness through her personal journey. In high school, her dream of becoming a professional tennis player abruptly ended when she was diagnosed with common variable immunodeficiency (CVID), a condition in which a person has lower levels of antibodies and higher risk of infections. Pate decided to pursue a medical career instead, but she had to consider her condition each step of the way — from timing her studying to her least fatiguing hours of the day to avoiding certain medical specialties due to her higher risk for infections.

As Pate navigated her own journey with chronic illness during her medical training, she gravitated toward patients with chronic conditions, as she knew firsthand the mental toll these diagnoses can take. Then, during her last year of residency, Pate was diagnosed with primary biliary cholangitis (PBC), a rare chronic liver illness, which produced another set of symptoms and challenges to overcome.

Pate’s experiences have given her a unique perspective as a psychiatrist that has allowed her to help patients with chronic liver diseases. For example, she understands the stigma that patients face because liver diseases are commonly perceived as tied to alcohol abuse (even though many liver conditions, including PBC, are not). She also has to proactively work to manage her own symptoms, like fatigue. For example, she identified the time of day she feels most free of fatigue — for her that’s the morning — and then schedules patients during that time. She encourages patients to take a similar approach.

“Being someone with a chronic disease makes me better at taking care of those who also have chronic disease,” she said. “I really liked the idea of being able to improve someone’s quality of life.”

A mental health professional can help with the management of physical symptoms, like fatigue or pain, or with comorbid mental health symptoms like depression that commonly arise in conjunction with chronic disease. Due to the “invisible” nature of psychological symptoms, patients may not seek to address them with the same immediacy as physical symptoms, Pate explained. However, tailored mental health care is an important element of a patient’s treatment plan. Patients who experience depression before liver transplant and go untreated are more likely to have longer recovery times after transplant.

Women are more likely than men to seek out mental health care, and Pate recommended all patients be prepared to openly talk about their experience and symptoms when seeking help. “You have to be the captain of your own ship,” she said.

Pate also noted that sometimes patients may be prescribed psychiatric medications that could make their symptoms worse, so it’s helpful to find a specialist who works with patients with chronic illness to identify the best treatment regimen. “Make sure you see someone who is familiar with medically complicated people,” she said.

Keeping health care information as organized as possible can also help patients feel more in control if they experience symptom flare-ups or a mental health emergency. She suggested documenting all medications and doctors’ visits, keeping clear contact information for different specialists, and ensuring that any medical information you gather comes from reliable sources. For trustworthy information, Pate pointed to livingwithpbc.com as a great resource for information and community-building.

Most importantly, Pate urged patients to “trust your own judgement” when gauging your symptoms. As the patient, you can best inform your care team about your experiences and help find the treatment plan that improves your quality of life in the face of chronic liver illness.

For more information from Dr. Pate, see this interview with IG Living Magazine. SWHR’s blog series on women’s liver health is supported by a grant from Intercept Pharmaceuticals Inc. SWHR maintains editorial control and independence over blog content.