One type of liver disease is known as primary biliary cholangitis (PBC) and is a rare and incurable form of liver disease. If left untreated, PBC can be fatal. PBC is most commonly seen among women aged 40 to 60 and symptoms include fatigue and weakness, but those symptoms are so vague that it’s very easy to misdiagnose the condition.
A common treatment for PBC is ursodeoxycholic acid, but 30 percent of patients do not respond well to it.
Many PBC patients require liver transplants as the only means of treatment.
Researchers from the University of Calgary’s Cumming School of Medicine may have uncovered a possible new treatment for hard-to-treat patients. They suggest that an antidepressant has been found to be successful in treating PBC by stopping its progression.
Dr. Abdel Aziz Shaheen came across the findings while studying the effect of depression on PBC patients. He uncovered a sub-group of depressed patients with PBC who had greater outcomes than other patients.
Shaheen explained, “At first, I thought I must have an error in my coding. As I began to look deeper I realized these patients were all taking the antidepressant mirtazapine, which seemed to be having a positive impact on their liver disease. You don’t expect to find people with a chronic illness and depression to be healthier than those patients who don’t have depression.”
To further investigate, Shaheen recruited colleagues and scientists to help determine what may be going on in the body that could contribute to the results. This led researchers to explore mouse models to determine the effects of the antidepressants on the liver.
Researcher Dr. Mark Swain added, “PBC slowly destroys the small bile ducts of the liver. Once damaged, the liver can ‘fill up’ with materials the body is trying to excrete, damaging the liver and leading to permanent scarring. Mirtazapine has significant effects on the immune system which appear to be protective of the liver. No one thought that an antidepressant could affect liver immunity. This leads to an entirely new line of inquiry, on how antidepressants may be used in the treatment of other chronic diseases.”
“This confirms how important collaboration is in the field of medicine. We are very lucky at the University of Calgary to be able to reach out to our colleagues in other institutes and departments to help solve mysteries to improve patient care. I couldn’t have explained this finding alone,” Shaheen concluded.
The research opens up a new door of possibilities in the treatment and management of PBC and offers greater hope for patients battling to treat this rare form of liver disease.
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