### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Hello, I have had slowly increasing mild elevations of liver enzymes over the last 9 months when they were initially discovered.I had taken venlafaxine 300mg and mirtazapine for 20 years for severe OCD. The previous 5 years I have had chronic fatigue syndrome which has been incapacitating for the last two years in particular with symptoms of ibs symptoms, extreme fatigue, mental fog and back pain.Depression and OCD has worsened also.Since the elevation of the liver enzymes I have changed medication to fluoxetine as venlafaxine was believed to be the cause of this but mental health is worse and no improvement in liver tests I am a 40 year old woman with pcos.My current alt levels are around 70, ggt 180,alp 134 and have had slow steady increases. Ultrasound showed only slight fatty changes.Do you think my worsening exhaustion could be partly related to liver?Should I have any further investigations for this before change in meds? Thank you.

### output:

Hi, His light fatty liver changes are a normal finding after an age of 40 years. So don't worry a lot about them. Though liver function tests are deranged, yet they are not that deranged that they cause fatigue. Fatigue and feeling of exhaustion are because of Fluoxetine which you are having for your OCD. Abnormal liver function tests were most likely because of Mirtazapine. Don't go for any further medication just ask your psychiatrist for few latest SSRIs like Paroxetine which are much safer and have significantly less toxic effects. Liver rejuvenated like Sylvain can be taken for 3 months to improve liver functions. Hope I have answered your query. Let me know if I can assist you further.  