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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by Mtom on August 29, 2018, at 15:58:21
Hi posted this to another thread but think it should be posted separately for discussion.
I currently take escitalopram. Have had adverse affects with all the AD's I've tried so far & interested in comments on Genetic Testing (would be great if Dr. Bob was able to weigh in with his opinion on these tests).
My Genetic testing showed an issue with my CYP2D6, a P450 enzyme involved with metabolism of most antidepressants and all antipsychotics. I have 1 active allele & 1 inactive/nonfunctional allele. Genetic research is controversial and contradictory on what this means as far as clearance of these drugs (e.g. whether clearance is slowed by the inactive allele, or if the active allele counteracts this). The report however was clear that the sources they used for Antipsychotics (they used a variety of sources based on levels of evidence) indicated I would have reduced metabolism of this class of meds with increased risk of adverse drug reactions including tardive dyskensia. The different source they used for antidepressants classify me as a normal metabolizer despite the inactive allele. My follow up conversations with them to clarify confirmed that my CYP2D6 alleles put me in a "contested" category and they choose the best levels of evidence they can find on each drug (which is limited & often poor quality), from various sources - so they can't comment further on the anomalies until more research is done. (and how many people are really getting funding for this type of research?)
Citalopram and Escitalopram are believed to be "mostly" metabolized by CYP2C19 for which my alleles are "normal". They may also be partly metabolized by CYP3A4, which the Genetic Company did "not" include in their tests due to lack of research. Some papers "believe" that CYP2D6 also plays a role in escitalopram metabolism, but research is little & inconsistent.
In years past I tried Zoloft, low dose amitriptyline, and very very low doze Trazodone (for sleep issues) and had intense side effects, extreme with Trazodone and especially with Zoloft after just 1 dose. Trazodone is metabolized by CYP3A4 which they did "not" test for so possible this could be an issue for me. Amitriptyline and Zoloft at least partially metabolized by my "controversial" CYP2D6.
Anyone delved into these Genetic tests in detail?
Posted by bleauberry on August 31, 2018, at 6:38:14
In reply to My Genetic Test results re AD's - discussion, posted by Mtom on August 29, 2018, at 15:58:21
Personally I don't think this test helps much. The whole science of it is still in its infancy. Aside from that, even if we know in detail how a particular gene or enzyme has been impacted, it doesn't do anything to actually fix the underlying problem. In your case, the best it might do is suggest an antidepressant that maybe is better tolerated for you, but has nothing to do with whether it will actually make you feel better or heal your disease that caused the genetic mutations in the first place. Whatever caused the genetic problems is likely the same thing causing the psychiatric symptoms, if you ask me.
In my journeys I have learned that sensitivity to meds has to do with one of these things:
1.Misdiagnosed Lyme disease
2.Leaky gut syndrome
3.Immune system destabilized (as in Lyme)The whole sensitivity thing is - big picture - the immune system reacting to something it should not be reacting to. For example leaky gut is very common in psychiatric patients and itself is a cause of the symptoms. It's when the intestinal lining has become compromised by infection, bad foods, sugars, and yeast. This allows molecules of undigested food to sneak through the lining straight into the blood system.
That also happens with meds, in a leaky gut situation. The raw drug seeps right straight into the blood causing a different reaction than if it was fully digested first.
Lyme itself, and other stealth infections, cause the immune system to be confused and overburdened. It starts to mistake normal things as enemies.
I think the whole genetic testing stuff is interesting and probably the science of the future. I had a very extensive exhaustive genetic test done several years ago - close to $1500 - and it showed many problems in the methyl areas, the B vitamin areas, and all sorts of issues. We'll never know for sure how all that damages happened. But in my case, Lyme is the most obvious likely reason.
Posted by linkadge on August 31, 2018, at 16:35:47
In reply to My Genetic Test results re AD's - discussion, posted by Mtom on August 29, 2018, at 15:58:21
This basically means that you may have higher levels of drugs that are metabolized by CYP2D6.
When they say that this means "possibly higher levels of TD or side effects" this is nonsense. Why? Because you simply lower the dose.
If somebody with fast metabolism and somebody with slow metabolism both take the same dose, the one with slow metabolism will have higher blood levels. This just means that the one with slower metabolism can get away with a lower dose.
They key is to start with lower doses, and increase slowly to see if the drug works, and if you can tollerate the side effects. Don't pay attention to a "theraputic dose", because its a "theraputic blood level" that matters.
Linkadge
This is the end of the thread.
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