Pruritus and/or fatigue may lead to depression in patients with primary biliary cholangitis (PBC)

  • The following symptoms were noted in a Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), study of patients with PBC and primary sclerosing cholangitis with a Beck Depression Inventory (BDI)a score greater than 101:
    • Depressed mood (24%)
    • Loss of interest (12%)
    • Feelings of worthlessness (9%)
    • Suicidal ideation (9%)
    • Psychomotor Agitation or retardation (3%)
  • In contrast, fatigue (itself a DSM-IV criterion) was present in 71% of patients with a BDI score of 101
  • Patients should obtain psychiatric support if they demonstrate depression and/or suicidal intentions2

aA standardized psychiatric questionnaire used in diagnosis of depression.


When patients are being treated for pruritus or fatigue, consider screening for depression.

References:  1. van Os E, van den Broek WW, Mulder PGH, ter Borg PCJ, Bruijn JA, van Buuren HR. Depression in patients with primary biliary cirrhosis and primary sclerosing cholangitis. J Hepatol. 2007;46(6):1099-1103. doi:10.1016/j.jhep.2007.01.036.   2. Michalak A, Hanc M, Fatyga A, Skublewska A, Prystupa A, Mosiewicz J. Pruritus in liver disease—pathenogenisis and treatment. J Pre-Clin Clin Res. 2011;5(2):47-49.