Specific medical therapies of fatigue associated with chronic cholestasis have not yet been defined. UDCA treatment seems to have no or limited beneficial effects on fatigue in PBC [217, 307] . Oral supplementation with antioxidants showed promising results in a pilot study, but had no beneficial effect in a randomized, placebocontrolled, crossover trial [308] . Independent of the underlying disease, altered serotoninergic neurotransmission has been implicated in the development of fatigue [309] . The 5-HT3 serotonin receptor antagonist ondansetron, however, did not significantly reduce fatigue compared with placebo in a randomized, placebo-controlled trial [310] . The selective serotonin reuptake inhibitors fluvoxamine and fluoxetine also failed to exert beneficial effects on fatigue in this patient group [311, 312] .