![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Greg on April 24, 2000, at 20:33:20
Cam,
Recently my doc added Prozac to my diet to help take the edgyness off the Wellbutrin SR I am taking. Within about 2 hours I was ready for a nap. I submitted a post asking anyone who has taken these 2 meds together to give me their experience and got very conflicting responses about their effects. Has there been any research done to find out why the same med can have such drastically different effects on people. I understand about body weight and chemical makeup and the like, but it seems puzzling to me that the effects can be so different.Peace,
Greg
Posted by Cam W. on April 24, 2000, at 21:08:34
In reply to Cam W. - Different Effects on the Same Meds?, posted by Greg on April 24, 2000, at 20:33:20
Greg - The reason that people react differently to the same drug is that we are all different from a biochemical point of view. We all have different quantities of the different neurotransmitters. For example, some have more norepinephrine receptors relative to serotonin receptors relative to GABA receptors relative to dopamine receptors, etc. Also, we differ in the numbers of receptor subtypes (D2, D3, 5HT2, 5HT6, etc.).A drug like Prozac, even though it is called a "selective" serotonin reuptake inhibitor (SSRI) also binds to a number of other receptors (norepinephrine reuptake and others). Different people have varying amounts of these receptors and therefore different side effects will be more prominent in people with more of a certain type of receptor.
Also, different people have varying amounts of different metabolizing enzymes. People with less of one kind of enzyme will need smaller doses of a drug, than some who produces more of that metabolizing enzyme. If someone with less metabolizing enzyme is given the same dose as someone with more, that drug may build up to higher concentrations in the bloodstream. Higher blood levels usually means more pronounced effects (and thus, side effects).
Also, to complicate things further, a person's psychological make-up comes into play. Some people are more attuned to their bodies than others and slight changes due to side effects are more noticeable to them. In pharmacy, we sometimes do not give the whole side effects profile to someone taking the drug. If you tell some people, especially a hypochondriac, that a certain drug may cause a certain side effect, you can be sure that they will get that side effect. This is where the art of pharmacy comes into play. Sometimes it is better to say that if a person feels different taking a medication they should call and then you can explain the side effect to them. This does not apply to relatively common, benign side effects (eg G.I. upset) or ones that are potentially life-threatening (eg rash with Lamictal).
Actually, it is even more complicated than this, but I think you get the general picture (I hope).
- Cam W.
Posted by Greg on April 24, 2000, at 21:59:05
In reply to Re: Cam W. - Different Effects on the Same Meds?, posted by Cam W. on April 24, 2000, at 21:08:34
Cam,
Thank you so much for your answers, it really does explain a lot. I have one more question for you, would a recovering alcoholic or addict have more of a tendancy to feel the "downer" effect from a SSRI than a person who has never had a drug or alcohol problem? I am a recovering alcoholic (13 years sober) and downer types of drugs hit me real hard, while upper types (sorry for not using the proper terminology here) have little or no effect on me at all. I'm really interested in knowing if my disease can play a role in how my other meds work (or don't work as the case may be). Thanks for always being so responsive.Peace,
Greg>
> Greg - The reason that people react differently to the same drug is that we are all different from a biochemical point of view. We all have different quantities of the different neurotransmitters. For example, some have more norepinephrine receptors relative to serotonin receptors relative to GABA receptors relative to dopamine receptors, etc. Also, we differ in the numbers of receptor subtypes (D2, D3, 5HT2, 5HT6, etc.).
>
> A drug like Prozac, even though it is called a "selective" serotonin reuptake inhibitor (SSRI) also binds to a number of other receptors (norepinephrine reuptake and others). Different people have varying amounts of these receptors and therefore different side effects will be more prominent in people with more of a certain type of receptor.
>
> Also, different people have varying amounts of different metabolizing enzymes. People with less of one kind of enzyme will need smaller doses of a drug, than some who produces more of that metabolizing enzyme. If someone with less metabolizing enzyme is given the same dose as someone with more, that drug may build up to higher concentrations in the bloodstream. Higher blood levels usually means more pronounced effects (and thus, side effects).
>
> Also, to complicate things further, a person's psychological make-up comes into play. Some people are more attuned to their bodies than others and slight changes due to side effects are more noticeable to them. In pharmacy, we sometimes do not give the whole side effects profile to someone taking the drug. If you tell some people, especially a hypochondriac, that a certain drug may cause a certain side effect, you can be sure that they will get that side effect. This is where the art of pharmacy comes into play. Sometimes it is better to say that if a person feels different taking a medication they should call and then you can explain the side effect to them. This does not apply to relatively common, benign side effects (eg G.I. upset) or ones that are potentially life-threatening (eg rash with Lamictal).
>
> Actually, it is even more complicated than this, but I think you get the general picture (I hope).
>
> - Cam W.
Posted by Cam W. on April 24, 2000, at 22:05:54
In reply to Re: Cam W. - One more question?, posted by Greg on April 24, 2000, at 21:59:05
Greg - I do not know the biochemical changes that occur from alcohol addiction. It might be a possiblity, but I haven't read any documentation on this. You are probably just more sensitive to SSRIs than most people for one or more of the reasons I previously stated in my last post. - Cam W.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.