DEAR DR. DONOHUE: My wife has primary biliary cirrhosis. It was diagnosed 24 years ago, but it never bothered her until this past January. Now she has many of the disease’s symptoms. Please discuss the prognosis and life expectancy. — C.S.

ANSWER: Your letter caught my attention for two reasons. One is to provide you with some information on your wife’s illness. The other is to make people aware that cirrhosis isn’t only due to excessive alcohol. Many other conditions cause it. This is one.

One of the liver’s functions is the production of bile, a substance that aids in fat digestion. Bile trickles out of the liver through a system of canals (bile ducts) and eventually makes its way to the gallbladder, tucked under the liver. There it is stored until a person eats a fatty meal. When fat reaches the small intestine, the gallbladder shoots a jet of bile into the intestine.

In primary biliary cirrhosis, the immune system assaults bile ducts with antibodies, which act like hand grenades that destroy bile ducts. Bile oozes into the liver and kills liver cells. Strands of scar tissue replace the dead liver cells. Eventually, the entire liver is filled with scar tissue. That’s cirrhosis.

What prompts the immune system to make these antibodies is a question that hasn’t been answered. Women around the age of 50, are most prone to develop this condition — why this is so is another unanswered question.

Fatigue and itching are two of the prominent symptoms. As more of the liver is destroyed, the skin and the whites of the eyes turn yellow — jaundice.

When primary biliary cirrhosis is in its early stages — as it sounds like your wife’s involvement is — treatment with UDCA, ursodeoxycholic acid, slows the progression of liver destruction and allows many people to live a normal life span. If liver failure does occur, liver transplant is an option.

DEAR DR. DONOHUE: My 92-year-old mother-in-law has been in a nursing home for more than a year. She was not able to take care of herself, and has the beginnings of dementia. Until January of this year, she was able to use a walker. She has deteriorated to 100 percent confinement to a wheelchair.

She takes Zyprexa, Aricept, Celexa (citalopram), trazodone, Namenda and nambumetone. Some days she sits in her wheelchair and can hardly hold up her head. She is very drowsy and nonresponsive. Is she overmedicated? Could some of the medicine be reasonably stopped to see if she improves? — B.B.

ANSWER: Aricept and Namenda are medicines for Alzheimer’s disease. Nambumetone is a nonsteroidal anti-inflammatory medicine use mostly for pain control and for countering inflammation. The other ones are antidepressants and medicines to restore clearer thinking. They all can be a cause of drowsiness. Her doses are on the small side, but the additive effect of these drugs could be the reason why she is so unresponsive. Your request is reasonable. Take it up with the doctor who’s prescribing her medicines. He or she may not be aware of how she is during the day.

DEAR DR. DONOHUE: I am an 84-year-old widower with all the symptoms you mentioned in your article on depression. Any advice would be appreciated. — R.H.

ANSWER: Ask your family doctor for a referral to a mental health professional as soon as possible.

Depression is an illness, not a character weakness. With the right medicine and with professional guidance, you will get better much more quickly than you would by waiting for the depression to lift on its own.

You really must make contact with your family doctor right away. If you don’t have a family doctor, then call the local hospital for the name of a psychiatrist.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.