Bi-Polar, Anxiety disorder, drug induced hepatitis, kava-st johns wort...safe?

Posted by Kevin on July 27, 1999 at 04:26:47
I am a 23 year old male. I was taking Depakote since 4/98,  for bipolar disorder and went toxic on it back in february/99. I have drug induced hepatitis and have been sick since feb. 28 1999. They took me off the depakote 1500 mgs day and the respidol 1.5mgs day I was taking for anxiety disorder. The only drug they kept me on for my mental problems was Lorazepam 2mgs day. I cant really take alot of medications people that have healthy livers can, since alot of drugs are metabolized in the liver, mine cant handle them right now, if I did take them my hepatitis would get worse leading to further liver problems. And i dont want to get sick like i did at first, its horrible the symptoms my hepatitis caused. The SEVERE itching that lasted 24 hours a day for alomost 4 months, the nausea and vomiting, weight loss(i got down to 113 pounds, i weigh at 119 presently), the jaundice, and the fatigue.  well about the lorazepam I took it as prescribed for a while then I realized I was addicted to it, so I finally quit last week, it took me almost 3 months to kick the habit. Ive been hooked on Klonopin few years ago for 3 years straight. After i finally kicked in the psych ward it took me over a year to stop having harsh anxiety/panic attacks in certain situations, but i still got them every once in a while. Anyways I am now recovering pretty well physically from my liver condition, but mentally the past few months have been hard. I get and have been getting major anxiety attacks, im paranoid, i get SEVERELY agitated sometimes, i also get these black depressions sometimes, and generally i feel pretty down about life and myself almost all the time, i have delusions like I think my family members are poisoning me to worsen my liver condition or one of them is putting illicit drugs in my food or in something im drinking when im not around, I think their out to get me, im imagining all kinds of conspiracys everywhere. I keep telling myself that your just seriously f***** in the head your feeling like this because of your isolation while being sick for so long and its just your imagination but then again it might all be really happening and it wont do any good to start accusing because they would just deny it and I cant prove it anyway unless i had some kind of solid evidence. Also, suicidal thoughts cross my mind constantly because of the way i am, and also because of various other problems, and the fact that i have fibrosis in my liver which means that i might not be able to take medications i might need in the future for illnesses-physical and mental without risking another recurance of my liver disease, it also means that i could develope sclerosis which can lead to cancer or a liver transplant, which my body will probably reject and i will probably die a horrible jaundiced, nauseated, itching, 75 pound death the way my luck has been going in this one trip we all get on this planet. You see I got off the lorazepam for few reasons, its making anxiety worse, its not good for my liver, and i want to see if this addiction is whats been making me feel so crazy or making my craziness worse. Anyways ive heard about this stuff called Kava Kava and st.johns wort this is supposed to be herbs, but is it broken down in the liver? is it safe to use? any feedback about how kava and st j wort are broken down in the body would be appreciated. sincerely, a very messed up individual

Posted by HFHS MD - RG on July 29, 1999 at 18:34:35
Dear Kevin,
    It is unfortunate to learn that the psychiatric medications may have caused a drug-induced hepatitis.
    Kava kava (Piper methysticum) is a plant native to the Pacific Island region, and has been used ceremonially for thousands of years. The active ingredients are a group of substances know as kava lactones (AKA kava pyrones). The mechanism for their psychotropic activity is through their inhibition of MAO-B (mono-amine oxidase B), a type of enzyme associated with depression, by kava pyrone-enriched extracts. Four lactones in kava have
been found to have significant analgesic and anesthetic effects via non-opiate pathways. Kava's most popular application is as a natural anxiolytic, comparing favorably in several studies to a number prescription medications, including benzodiazepines such as Xanax, Valium, etc. Central Nervous System (brain+spinal cord) effects seem to be mediated by several mechanisms. Studies have been conflicting regarding its GABA(a inhibitory neurotransmitter gamma-aminobutyric acid), receptor-binding capacity, although this has been found to occur in some studies. In vitro(laboratory-controlled studies), kava has been found to block
norepinephrine uptake.  The most common side effect, usually seen only with long-term, heavy usage of the herb, is a scaly skin rash called "kava dermopathy." It has also been know to potentiate other medications such as barbiturates and Xanax.
    Extracts of  St. John's wort (Hypericum perforatum), have been used since antiquity for the treatment of depressive symptoms. A number of clinical studies conducted over the past few years have indicated that whole extract of St John's wort has antidepressant effects which offers promising results in the treatment of patients with mild and moderate depression. The constituent of hypericum extract that is responsible for the antidepressant effect has not been identified. Nor is the mechanism of action known, but a combination of low-grade monoamine oxidase inhibition and noradrenaline and serotonin reuptake blockade seems the most likely alternative, though other interesting mechanisms have also been proposed. Since themechanism of action of St John wort is uncertain, concomitant use with monoamine oxidase inhibitors and selective serotonin
reuptake inhibitors is ill advised. There are no controlled head to head studies comparing it to standard antidepressants, so it is not recommended as treatment of choice.
    The medical community in the United States at the present time is not widely using this type of treatment as they are not currently FDA approved. Until then I would advise you to refrain from using these medications as our knowledge of its side effects and potential harm is very insufficient.
    Lithium is metabolized by the kidney and may have beneficial effect on your mood swings and depression. I strongly recommend a psychiatric consultation.
    
    The information provided in this Forum is presented for general educational purposes only. Specific questions you have pertaining to your health should always be directed to your personl physician or you may call Henry Ford Behavioral Health at(248) 689-7476 for an evaluation.
I wish you the best,
HFHS MD - RG
*Keyword: Kava kava, St Johns Wort