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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by Bill82 on February 24, 2015, at 13:40:07
Have bad OCD, currently pretty disabled. Have had bad reactions to many medicines. Got my genetic testing back some interesting stuff. Was prescribed lamotragine so we will see how that goes. Worried about memory or libido problems but have told myself I will just white knuckle it until he says to stop, unless of course I have serious side effects such as steven johnson rash or other allergic reactions. Anyways check out the results and if you have any hhoughts post them I'd love to hear.
SLC6A4- result-L(A)/L(G)
Serotonin Transporter-patient exhibits a mutation of the serotonin transporter associated with reduced reuptake of seritonin, less satisfactory response to ssri, and a potentially greater risk for adverse effects from ssri. This variant has also been associated in literature with lower stress resilience and higher rates of PTSD.
5ht2c -Serotonin Receptor result- C/C
Serotonin has potent satiety signaling activity and 5ht2c antagonism has been shown to lead to increased food intake. This patient exhibits a variant of the 5ht2c receptor which has been associated with satiety in the hypothalamus.
CACNA1C Calcium Channel-result G/A
The patient exhibits a variant in the gene coding for a subunit L-type voltage gated calcium channel. Days regulation of this channel has been associated with changes in neuronal depolarization, amygdala volume in schizophrenics and bipolar patients, frontal hippocampus connectivity, disruptions in cognition in both schizophrenic and bipolar patients, and has been hypothesized to be related to glutamate signaling. Clinically has been associated with conditions charecteriEd by mood instability or lability.
Mtfhr-impared folic acid metabolism and blunted activation in the anterior cingulate.
CYP2D6 - cytochrome P450 2D6- result - intermediate metabolizer
Reduced hepatic degradation and higher plasma levels of flouxetine fluvoxamine paroxatine sertraline duloxetine venlafaxine mirtazipine nefazadone apriprazole haloperidol iloperidone risperidone atomoxetine amphetamine-dextrothetamine methamphetamine olanzapine codeine methadone tramadol vortioxetine TCA's phenothiazines
CPY2C19 Cytochrome p450 2C19- result - ultra rapid metabolizer
Poorer efficiency and reduced plasma levels of citalopram escitalopram diazepam clomipramine imipramine trimipramine
Posted by linkadge on February 24, 2015, at 16:19:57
In reply to Got genetic results., posted by Bill82 on February 24, 2015, at 13:40:07
Wow. Very cool. Is this the extent of the results? Did they look at other variants such as COMT, MAO, sodium channels etc.?
Can I ask where you got this done?
Based on this info, it seems prudent to avoid SSRIs. It seems you have a more active version of the 5-ht2c receptor. Can I ask about your weight. Do you weight more / less or normal? You might benefit from a 5-ht2c antagonist such as agomelatine or mirtazapine. Also, depending on the variation in the calcium channel, you might try a calcium channel antagonist instead of lamotrigine (which I believe is mostly a sodium channel antagonist). Taurine works as an l-type calcium antagonist. Verapamil (usually used for blood pressure) a calcium L-type antagonist might be worth a shot. You might also wish to try methylfolate.
Posted by Phillipa on February 24, 2015, at 16:48:11
In reply to Got genetic results., posted by Bill82 on February 24, 2015, at 13:40:07
Per a psychiatrist website
Posted by Bill82 on February 24, 2015, at 17:45:01
In reply to Re: Got genetic results., posted by linkadge on February 24, 2015, at 16:19:57
This was all I tested positive for. They also tested for these which I was considered normal.
DRD2 (Dopamine Receptor Subtype 2)
ANK3 (ankyrins- has to do with sodium ion channels)
COMT (Catechol-O-methyl transferase)- breaks down dopamine in frontal lobes
CPY3A4/5(normal-90% of Caucasians are poor metabolizer a so they consider that normal,I'm Caucasian too)It was done by a company called genomind, was exspensive though, around 4-5k US dollars, so you'll have to see about insurance or bite the bullet.
And I have had a very bad reaction to ssri, they don't seem to do much and I get vocal and motor tics while on them, however most drs didn't believe me or said my anxiety was making up the symptoms, hopefully they will now haha.
I had thought about agomelatine but I'm in the United States, so not sure where I could get it and be sure of it's purity. I have tried mirtazipine but that induced a rapid appitite(as did risperdal) and also induced rages/anger(of which risperdal also did.
That certainly is a thought, and if the lamictal dosnt help the ocd I will definitely keep it in mind. Do you think those could help ocd at all?
And I actually have tried methylfolate or deplin(brand name) and had to stop because I would get severely saddened/blue every time I tried it, tried it 3 separate times. It could have been placebo or coincidence, but so far my parents have not wanted me to try it again.
My ocd is also potentially infection induced, as it happened very suddenly over a month at school after I got mycoplasma p. The symptoms progressed rapidly and I was left with severe ocd seemingly out of nowhere, leaving me pretty much housebound. So I am open to all suggestions haha
And that's an interesting find Philipa
Posted by Bill82 on February 24, 2015, at 17:53:17
In reply to Re: Got genetic results., posted by Bill82 on February 24, 2015, at 17:45:01
Forgot to mention I'm 6"2 180lb so I guess normal weight.
Posted by Phillipa on February 24, 2015, at 19:04:12
In reply to Re: Got genetic results., posted by Bill82 on February 24, 2015, at 17:45:01
Thanks your infection at school goes along with the theory of inflammation for just about all diseases. CPK elevated. And I did have Lymes and still test postive but docs here don't believe it exists in NC. But it exists all over the world. Phillipa
Posted by linkadge on February 24, 2015, at 19:29:54
In reply to Re: Got genetic results., posted by Bill82 on February 24, 2015, at 17:45:01
Hmm. The results are interesting. However, I am wondering to the weight of the individual gene results also considering the weight of unknown genes which may trump.
As for the 5-ht2c thing, if somebody had an overactive 5-ht2c receptor, it is still possible for too much of a 5-ht2c antagonist to shift one into a state of under activity.
I think that I probably have an overactive 5-ht2c (or underactive cannabinoid system). I am 6 feet 2 inches and about 125 pounds. I can't gain much of anything. The right amount of remeron works for me, but too much and I get rage / anger issues too. Mice lacking the 5-ht2c receptor tend to be overaggressive, so the fact that 2c antagonists induce anger is no surprising.
If the study says normal ANK3 but bad CANAC, I would tend to take a L type calcium antagonist rather than a sodium channel blocker. Verapamil would be better than say tegretol or Depakote as these hit other targets. Deregulation in calcium homeostasis can induce all sorts of mood irregularities. I think that the ANK3 is more liked to classic bipolar whereas the CANAC is lined to affective instability, and interpersonal sensitivity / anxiety traits.
I have often thought (although I have no proof) that I have a deregulation in 5-ht2c and some sort of ion channel. I also think I have some dopamine or GSK-3 circadian rhythm issues.
Of course, there are a lot of unresearched or under researched areas such as opioid, cannabinoid, immune system, epigenetic, hormonal and gabaergic etc....
I'm hoping that, in my lifetime I can really nail down the key gene or gene's which affect my illness. But, this is all in its infancy.
Linkadge
Posted by linkadge on February 24, 2015, at 19:32:11
In reply to Re: Got genetic results., posted by Bill82 on February 24, 2015, at 17:53:17
>Forgot to mention I'm 6"2 180lb so I guess >normal weight.
Hmm. I am your same height but about 60 pounds lighter. When somebody sneezes, I tend to blow away. Sometimes, lampposts block be from peoples' views.
Linkadge
Posted by linkadge on February 24, 2015, at 19:34:24
In reply to Re: Got genetic results. » Bill82, posted by Phillipa on February 24, 2015, at 19:04:12
Yeah. 5K USD is too much for me right now. I have saved about $200,000 USD, but I also have extreme money hoarding tendencies. I start to get palpitations even thinking about spending money.
Linkadge
Posted by Bill82 on February 24, 2015, at 20:08:45
In reply to Re: Got genetic results., posted by linkadge on February 24, 2015, at 19:34:24
Just tell yourself that in spending some money to get better, you will get better, become more productive, then end up making more money :D basic economics, in low amounts saving and being fugal (logarithmic) is the way to go, but past a certain point, spending(which is a form of investment) increases monetary gain at a faster rate(kind of like exponential growth). That is just a thought if you have actually hoarding psychologically. If not I say congrats, you gotta be doing something right! I'm dead broke at the moment haha, probably a good thing as I can't drink though. What about keppra, would that be any different than lamotragine? Really I'm at a loss to my ocd, as I react very poorly to ssris, can't take mirtazipine or antipsychotics, and benzos I get extremly addicted to them and usually od within a day or two(has happened 4 times so far, been on them 4 times so far lol)
Posted by Bill82 on February 24, 2015, at 20:11:44
In reply to Re: Got genetic results., posted by Bill82 on February 24, 2015, at 20:08:45
If you want to gain weight try lifting, you will suck at it at first, but keep doing it, high weight(compared to your 1 rep max) and low reps. I've seen people with your build who can't gain weight make a lot of progress by sticking to that. Better in my opinion than using canibinoids antihistamines or 5ht2c antagonists to make yourself eat. Sprinting too can help a lot, better than running or jogging.
Posted by Bill82 on February 25, 2015, at 16:38:20
In reply to Re: Got genetic results., posted by Bill82 on February 24, 2015, at 20:11:44
Does anyone know what the gene about the calcium channels means? Does this mean I have increased, decreased, or some other variation to calcium channels? Having trouble finding what it means.
Posted by linkadge on February 26, 2015, at 15:39:29
In reply to Re: Got genetic results., posted by Bill82 on February 24, 2015, at 20:08:45
>Just tell yourself that in spending some money >to get better, you will get better, become more >productive, then end up making more money :D
But, I am not certain (to be honest) that such a test would lead to clinically meaningful results for me. It could be that it would, however, I would need to see some more reports of individuals having success using such information to guide their treatment.
>basic economics, in low amounts saving and being >fugal (logarithmic) is the way to go, but past a >certain point, spending(which is a form of >investment) increases monetary gain at a faster >rate(kind of like exponential growth). That is >just a thought if you have actually hoarding >psychologically.I agree with that logic to an extent. However, I believe that there are actually few purchases that genuinely meet the criteria for such spending. Every purchase that I could make, I analyze to death in terms of its potential to actually make me more money down the road. I can honestly not think of a single thing that I could buy now, that has a high probability of making me more money down the road (which I have not already purchased).
>What about keppra, would that be any different >than lamotragine? Really I'm at a loss to my >ocd, as I react very poorly to ssris, can't take >mirtazipine or antipsychotics,
Yeah, I think keppra is a mixed calcium sodium channel antagonist. You don't really know unless you try, I guess.
Linkadge
Posted by linkadge on February 26, 2015, at 15:41:25
In reply to Re: Got genetic results., posted by Bill82 on February 24, 2015, at 20:11:44
Everybody who weighs more than me has a strategy to help me gain weight. None of which seem to work. I have done weight lifting. The problem is that I seem to plateu to a point where I just can't do more reps from one day to the next. I get a bit of tone, but very little bulk.
Linkadge
Posted by linkadge on February 26, 2015, at 15:47:35
In reply to Re: Got genetic results., posted by Bill82 on February 25, 2015, at 16:38:20
>Does anyone know what the gene about the calcium >channels means? Does this mean I have increased, >decreased, or some other variation to calcium >channels? Having trouble finding what it means.
Hi. Good question. I don't know for sure. However, certain variants of the gene have been linked to different functioning of the calcium channel. In short, the calcium channel regulates the release of calcium from cells which impacts cellular communication and ultimately the rate and pattern of neurotransmission in certain areas of the brain.
In epilepsy, for instance, calcium and sodium channels may be overactive, resulting in too much brain cell activity leading to seizure.
Do you know the exact variant of the gene that you possess? You could go to pubmed.com and type this in. You may be able to locate studies discussing this particular genetic variant.
Linkadge
Posted by jrbecker76 on March 4, 2015, at 14:43:53
In reply to Re: Got genetic results., posted by Bill82 on February 24, 2015, at 17:45:01
Did you end up paying the full $4-5K amount or did your insurance pay most of it?
I took a similar test with a different company and it was probably a similar total cost billed, but thankfully, despite my insurer declining coverage, the company has a financial assistance program that ended up only making me responsible for $50 of the total fee. The results were well worth the apportioned cost.
JB
Posted by Bill82 on March 5, 2015, at 16:33:59
In reply to Re: Got genetic results., posted by linkadge on February 26, 2015, at 15:47:35
Link it sounds you would be a good fit for trading stocks and bonds. The frugaler the better and you can make a lot in the process. As for weight all I can say is eat a lot, and lift. If you need help eating, best things I know are pot and low dose alchohal(aka a buzz). Both of which I don't think would be good long term haha. Or mirtazipine will do the trick too, but you said that made you pissed.
And I ended up just saying screw it and buying the test and seeing if my innsurance would pay for it later. Honestly glad I did, as now I have proof for when drs don't beleive me that ssri were making me worse and feel awful
This is the end of the thread.
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