Dear Lindy142, Buspar is a mild anti-anxiety agent used for treatment of generalized anxiety disorder. Unlike benzodiazepines, there is no immediate effect, and also no addiction potential. The usual dose is 30-60 mg/day but sometimes higher doses (up to 90-120 mg/day) are needed. An adequate trial usually would be about 4-6 weeks at a dose of 30-60 mg/day.
Concerns about excessive liver consumption due to its retinol content (ie, Vitamin A from animals) come from a 1987 report by the British Teratology Society, whose expert panel determined that consuming more than 10,000 IU of Vitamin A per day posed a possibility for birth defects. A 1990 report in the British Medical Journal noted that the average retinol content in liver (at least in Britain) is about 66,000-130,000 IU per 100 grams, with the conclusion that liver intake should be no more than 100 grams (about a quarter pound) per week. There are case reports of birth defects in women who have consumed 25,000 IU of Vitamin A or retinol on a daily basis in pregnancy. Risk may be especially high between the 4th and 10th weeks of a pregnancy when the placental barrier between mother and fetus is incomplete. One pound is a little less than half a kilogram (ie, a little under 500 grams), so, this quantity does exceed the usual recommendation. It would probably be hard to gauge the likelihood of birth defects from consuming 500 grams/week of liver but it's obviously worth discussing with your obstetrician; routine ultrasounds should certainly be able to answer the question. If your OB is not familiar with this information it is well-summarized in BMJ 1990; volume 301 p. 1176.
The so-called "chemical imbalance" theory, which was put forth in the 1960's, has been out of date for a good 10-20 years. Current neurobiological theories about depression or other mental illnesses propose that rather than a problem with chemistry or neurotransmitters, the problems lie in faulty functioning or inefficiency of brain circuits that connect regions involved in emotional processing, thinking, perception or behavior. The thinking is that someone has to have a biological vulnerability to developing depression (or schizophrenia, or alcoholism) and that somehow, interactions between someone's biology and experiences (ie, the environment) can reveal their predisposition. It can't all be genetic because even in identical twins, if one has a psychiatric disorder, the concordance or existence of that illness appearing in the twin is far from 100%. Likewise, not everybody who endures trauma or other bad circumstances gets depressed, at least in the clinical sense of depression. Circumstances don't cause clinical depression, but stress can sometimes precipitate or reveal the vulnerability. The analogy I think of is hay fever. Not everyone sneezes and gets a runny nose when exposed to pollen, but someone with allergies will. The pollen doesn't cause the allergy, it triggers symptoms in someone who has the biological vulnerability (the allergy) to begin with. Factors that we think protect a biologically vulnerable person to developing depression, anxiety or other disorders are thought to reflect resilience. Some genetic variants probably protect people against certain kinds of stresses or diseases (for instance, having sickle cell trait protects people against malaria; having a certain form of the gene for the serotonin transporter may help protect against depression). This is the very crux of the interaction between nature (biology) and nurture (the environment). Hope this helps.
Dear Natasha, Tough spot to be in if you aren't able to talk to your doctor about important healthcare decisions. Choosing to stop lithium has its risks, and whatever symptoms it was prescribed to treat could readily come back. Discussing your side effect with your doctor gives you and him or her the chance to determine if the weight gain is from the lithium or another cause, if the weight gain is manageable with lifestyle changes or other methods, if the lithium is helping your symptoms, and if you were to stop lithium, the all-important question of what would be put in its place. So this is really a critical and complex decision. If people do gain weight from lithium, it's usually pretty gradual, so rapid weight gain in just one month would lead one to suspect other causes. It would seem to me that the safest thing your could do for yourself is to make an appointment with your doctor to discuss all of the above rather than decide on your own to take your chances by just stopping (or even weaning off) a medicine only to then find out the hard way what might happen.
Dear Nightblinkers, Difficult and unusual situation. The abdominal pain sounds like a puzzle and not something readily explainable either from Depakote or modestly elevated liver enzymes. Weight gain per se can cause fatty liver, regardless of what medicine(s) may have contributed to it. If your own doctor is at a loss about next steps and recommendations it may be worth having a live consultation with an expert who can review everything in more detail and offer recommendations about best options. Dr. G.View Thread
You describe an unusual and curious problem. Depakote can raise liver enzymes but there's no reason why that would be associated with any type of abdominal pain. Generally, so long as liver enzymes do not exceed 3x the upper limit of normal, we don't necessarily stop Depakote, and just continue to monitor. Has your doctor run hepatitis panels and made sure there isn't an unrelated liver problem?
One would also be curious about whether the right-sided abdominal discomfort you mention could be an artifact of surgical adhesions from the appendectomy. Was it laproscopically or openly performed? Had your appendix ruptured, and was there any peritonitis?
Regarding the indigestion and heartburn, are you taking brand name Depakote ER or generic divalproex? GI side effects are fairly common with generic. Adding an H2 blocker like Pepcid or Zantac (over the counter) can also help.
This all sounds worth getting a second opinion from a really good gastroenterologist, since you want to be sure the Depakote isn't a red herring in all this. If in the end it remains a mystery, sometimes Depakote can be more effectively used at a lower dose when paired with lithium, for their synergistic benefit (and lithium has no hepatic effects, just renally excreted without being metabolized by the liver).
Latuda has minimal antihistamine effects, unlike Seroquel, making it much less sedating. There is no direct dosing comparison between the two drugs; they are fundamentally different. Furthermore, it's not clear that higher doses of Latuda work any better or differently than low doses. In bipolar depression, 20-80 mg/day was effective; higher doses yielded no greater antidepressant effect. In the schizophrenia studies, 40,80,120 and 160 mg/day all worked for psychosis with no clear pattern of one dose being any better than another. Sedation can occur in about 10-15% of people and may be dose related, along with nausea and restlessness. There are no studies in mania but most people assume the drug has antimanic value at 40 mg or above.
Dr GView Thread