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The theory explains why depressed patients have atrophied limbic brain regions on imaging studies and low hippocampal BDNF postmortem (Duman & Li, 2012)

These tend to be most noticeable when you first start or after a dose increase, and they typically ease up as your body gets used to the medication

The dose is then gradually increased over several weeks under medical supervision

Recommended assessments include fasting glucose and hemoglobin A1c to evaluate glycemic control, lipid panel for cardiovascular risk assessment, and morning total testosterone measured on two separate occasions if low levels are suspected

This can occur via anomalous pulmonary veins, defects at the atrial or ventricular level, or sometimes systemic arterio-venous fistulas