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In-depth article about how genetics informs how you process drugs, and also how it affects drug interactions, and the genetic tests used to determine if you will likely react badly to a drug or not.  It's written by a forensic medical examiner.  I've only skimmed it but seems well worth a read through.

 

https://www.madinamerica.com/2017/01/cyp-testing-prevent-dangerous-adverse-drug-reactions/

 

 CYP Testing to Help Prevent Dangerous Adverse Drug Reactions

 

 

January 24, 2017

 

Readers of this website might be aware that antidepressants can cause suicide, other violent behavior and even homicide. These can be side effects or adverse drug reactions from the medication taken. Not only can antidepressants cause these side effects, but basically every psychoactive medication can put patients at risk. Few people may know that there are DNA tests that can identify individuals who might be prone to these adverse drug reactions.1

 

To understand what kind of information such a test would provide, it might be helpful to explain the science behind these DNA tests.

 

In general, human cells contain 23 pairs of chromosomes. The father donates half of the chromosomes; the other half comes from the mother. Every chromosome contains many genes. A gene is the part of the DNA that codes for proteins, and proteins cause hereditary characteristics to be expressed. A gene can have two forms, called alleles. If someone inherits the same allele from the father and the mother, the person is called homozygous for that trait; if they are different, the person is heterozygous.

 

Medication needs to be metabolized to be expelled from the body. This is done by certain proteins called enzymes. Most medications that interact with brain chemistry are metabolized by an enzyme system called Cytochrome P450 (also known as CYP450 or P450). There are many different P450 enzymes, and they are divided into families and subfamilies. Cytochrome P450 family names are denoted by an Arabic number (e.g., CYP2), the subfamily by a Roman uppercase letter (e.g., CYP2D), and the individual enzymes by another Arabic number (e.g., CYP2D6). The alleles are indicated with an asterisk and a number, separated by a forward slash.

 

More at above link...

 

 

 

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Thanks for posting US

 

"Within minutes, a doctor can get a clear indication whether the medication he or she is about to prescribe can be a danger to the patient. If those extra minutes can save a patient’s life, they are well spent."

 

Personally i would have thought all these so called medications are dangerous.

Dangerous to start and even more dangerous to stop regardless of what cyp one has or doesnt have.

Is wdl a serious adverse drug reaction? Its a serious adverse event right?

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In clinical trials, the adverse events are defined as any undesired effects started AFTER first dose of the investigational drug, and within 30 days AFTER the last dose of the drug. But sometimes the 30 day is not added into the period, instead only the day of the last dose.

 

Majority of the SSirs were tested in trials with only 8-12 weeks treatment period, so the adverse events collected and reported are those occurd during those few weeks only. While withdrawl usually starts some days/weeks AFTER the last dose so most of those were not reported, as for the immediate drug reaction, those should be collected and reported.

 

The post market adverse events are supposedly reported if they are serious, and reporting is solely based on patients and/or doctors. I doubt many ( even the ones in this forum with most severe and serious events) ever report.

 

Drug companies are required to update the drug insert/labeling from the post market reported serious adverse events. That's all.

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Wow thats a fantastic post Lex.

Thankyou for that information.

No wonder the drug companies have got away with murder we all know the wdl can be delayed for a month or two or three.

Yet after 30 days the drug gets off the hook. That is criminal.

 

You are right about doctors not reporting i mean why would they there is no incentive too admit they had harmed  a patient.

In fact i know this is true cos i requested my ex doctor file an adverse events report and he refused.

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Some ppl reported, and how the black box warnings were added to these drugs insert.

 

What really should be added to the psych drug approval process, is trials for withdrawal. Currently no trials on withdrawal for any drug is required by FDA. It puzzles me why, after so many years so much data for withdrawal issues for these drugs.

 

The ugly truth is, withdrawal problem is not unknown by the drug companies, as shown in the inserts of these drugs saying you need to reduce slowly, but the whole picture of withdrawal is not mentioned at all, a big misleading to new patients thinking as long as you taper slowly ( they also suggest like in a few weeks or so) then you will be fine, until you find the whole hell yourself too late.

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wdl is 'mild an mild and short lived' ....yeah right!

 

I told my ex doctor how is it a drug can be said to be not addictive but then you are told you have to stop it slowly. Does that not seem odd to you ...you've got some brains why arent you using them!!

Then he appeared in a local newspaper two months later in an article titled ' Pill popping ends' . 

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Great, studies advocating the safety of toxic drugs to people with magic genes. Give me a break (no offence)

 

This would not have stopped me being harmed, I was seemingly fine for 20 odd years before I was harmed. The drugs change your brain REGARDLESS. you cannot take fraduelent brain interfering drugs everyday full stop.

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Thanks for posting US

 

"Within minutes, a doctor can get a clear indication whether the medication he or she is about to prescribe can be a danger to the patient. If those extra minutes can save a patient’s life, they are well spent."

 

Personally i would have thought all these so called medications are dangerous.

Dangerous to start and even more dangerous to stop regardless of what cyp one has or doesnt have.

Is wdl a serious adverse drug reaction? Its a serious adverse event right?

 

Hi nz11,

 

I think Lex is correct, withdrawal is technically officially an ADR.  However where the tests are relevant I don't think they predict who will have a bad withdrawal and who won't.  Aside from doing a badly planned taper or going cold turkey, which surely does increase the odds a bad withdrawal will occur, I don't know that there is a means of predicting if withdrawal will show up or not.

 

Also I had a professional refuse to report my ADR so I just reported it myself.  I don't know if that's an option in every country but where it is it's probably a good idea to self-report...as from people I know who work in medical fields I'm sure they almost never bother. However I'm convinced that the reports probably just fall right into a garbage can at the agencies they get sent to...surely if they were listening to us they'd have taken more meaningful steps to protect the public from being harmed by the drugs. 

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Great, studies advocating the safety of toxic drugs to people with magic genes. Give me a break (no offence)

 

This would not have stopped me being harmed, I was seemingly fine for 20 odd years before I was harmed. The drugs change your brain REGARDLESS. you cannot take fraduelent brain interfering drugs everyday full stop.

 

I agree with you and nz that the drugs are dangerous period.  Their basis for use is generally bogus  since they've said the imbalance theory has been discredited (although there are a number of necessary uses, for example to prevent withdrawal in those already on them to name one...)

 

However if the tests help prevent more people from being started on the drugs and avoid more reactions then I think they are a step in the right direction so long as they don't ever get to a point where they use tests to "prove" someone will tolerate a drug. I realize the tests have limitations, I am not sure my own reaction would have been caught by the tests either. 

 

The article is useful though for arguing with professionals who insist that the drugs never harm anyone, given they regularly dismiss our "anecdotal evidence", something coming from a forensic medical examiner surely would carry more weight.   

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Withdrawal is bad for business so is genetic testing..... less people taking drug less people buying drugs it is that simple it really is. 

 

Testing is now cheap and we can get it ourselves... we should all do this if we can is my idea.  I have found to be not a good candidate for these drugs... after 18 years on them... I paid for the testing.. the trial by fire of wd and the state I find myself in now is what brought me to this point... and still testing after is too late.  

 

There does not seem to be any help for healing once the damage is done and I don't think we all heal and walk into the sunset some of jerk out way into nursing homes... yes my imagination and worst fear are showing. 

It is scary as hell to not be able to control my body... I want to walk it won't I want to breath it won't... I want to ... you name it... it won't...

it is a raw deal for sure.  I have times if I am real careful and stay out of the way of chemicals ect... I can have a good enough day to take a walk and maybe not use a respirator... but it is not a given. It is a rough go... just now hoping it gets better... I am doing everything I can think of. 

WD is scary debilitating and if this is now the long term effects of drugs I should never have taken it is quite scary too... I don't see a way out.. for others growing up now I don't see pre testing coming into play unless there is a huge major push or something bigger happens... 

maybe every parent will test their kid at 23 and me to safe guard their health surely poor people would not be able to do it only the rich... but it could be a start. They are not going to test their kid unless they have a reason maybe autism fear or something... it could happen... k I am running on... not sure what the op was about at this point... 

wishing you all peace B

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though i am in support of P450 testing as a standard pre-drugging measure, because more information is generally a good thing, it does not weed out most negative responses or serious risks.  poor drug metabolizing is only one of many problems that can result in bad outcomes, including catastrophically bad outcomes.

 

though genetic testing is sometimes marketed as matching people to more ideally effective or tolerable drugs, meta-analyses fail to show substantial benefits.  this is partly because we have no idea what positive responses entail on a physical level and there are no uniform connections to our DNA.

 

tests for liver enzyme functionality specifically are basically just useful in guarding against the few times where someone can have a predictable negative reaction due to significant difficulties with the metabolism of many common psychiatric drugs.  a good tool, but not one which greatly diminishes the overall risks.  more appropriate prescribing, for example, would reduce preventable harms by an order of magnitudes.

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"appropriate prescribing"

 

Where will we ever find that?  

 

If you happen to be one of the people who cannot metabolize a drug and the side effects are killing you and all you hear is you have to stay on it for 8wks ....it takes 8wks to work... side effects will lessen and your body will adapt in 8wks... 

 

while you having a drug reaction ..... 

 

I have checked my results and tho I have not had a professional interpret them yet it would seem I was drugged for 18 years of my life with drugs I could not metabolize... causing side effects of all manner. 

 

Appropriate noticing of a drug reaction would be on my list lol sorry I have to laugh cause it is all so devastating it really is. Looking a the big picture of a life and this is just one life.. I am positive I am not the only one. 

 

I am trying to learn more as I learn I will tell you want I find. 

peace IU...

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"appropriate prescribing"

 

Where will we ever find that?

precisely why i think it is only a very minor feature. there are much bigger difficulties and obstacles which are standing in the way of reducing preventable harms. it is still quite relevant for the few people who avoid a serious drug reaction due to screening, but most of the problems--including most of the long term problems--are not going to be avoided this way.

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I am not sure IU until we know how many people are actually affected by genetic reactions... it is hard to say which could be more pressing all issues are pressing.  First in all of it would be for a doctor to believe his patient and not run to the book all the time but think outside the box.. empathise a bit.  When I had a real bad reaction I was thought to need more drugs to fix it the thought of what it was like for me to live thru and after.. knowing an existence terror horror.. could happen to a person and could happen again should i not take my meds... there was not talk of that not processing of what was my reality in that situation... that is something I would hope would improve in the future... help to deal with horror be it drug induced or mental illness... mine happened to be a SAR ... but it took 20 years of it never happening again and 10 years off drug... so 30 years before I believed it was not possible to live thru something like that again... that is was indeed drug induced... there are a lot of corridors in this rat tunnel to go down and take a look and shine some light in... lots of tunnels that is for sure. 

Know the truth behind the science of the drug and the science of the person ... = the interaction would be a good start it would seem but there is a long way to go in a many respects.  

It is possible to see looking at say my genome for example that I will not respond well to antidepressants will have severe adverse reactions to AP s ... from how it looks now I am just starting to sort it... but warning on the first page for ADs 15... 

 

One day we will be far ahead of where we are now it has to start with science and telling the truth of what these drugs do.. the good the bad sorting when they may be worth the risk.. knowing the risk means using genetics to understand the human.  It is so easy to do now there is not reason not to. 

 

Guessing has been part of medicine in all times.. the reason it was called medical practice ... a lot of trial and error but we have come so far.  Guessing is far too risky.. and there is no longer any reason to guess. Along with admitting the dangers chances would naturally happen to how the drugs are prescribed in a perfect world that and genetic testing would all take place before  drug was handed out.

 

I can be a dreamer but maybe we need something to shoot for... now how to get the ones calling the shots to buy in? 

 

Always love talking to you IU... I think I miss this place... I can't be online as much as I use to due to health issues I hope to be back strong in the future..

wishing you peace

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I am not saying we don't need decent doctors and a forum that is willing to shake off the old and run with the new... doctors and can't think of the word... sorry brain freeze systems that docs work within... all need to chance.  I have been looking at genes some information is right there for the taking some times it surprises me what I can find by accident. 

 

shows if you have this gene you have an increased chance of suicide within 30 days of taking citalopram I think that is what it says... so don't give this person that drug easy enough or it should be.

 

https://www.snpedia.com/index.php/Rs4675690

 

It does not matter how good the tools are that humans make if they can't use the tools all is lost. Don't ask me how to fix the human race I am barely holding my own.... that is almost funny.  Maybe machine could do this part... check your dna offer which drug is best.. then let a human oversee it all.  ;) 

peace

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In clinical trials, the adverse events are defined as any undesired effects started AFTER first dose of the investigational drug, and within 30 days AFTER the last dose of the drug. But sometimes the 30 day is not added into the period, instead only the day of the last dose.

 

Majority of the SSirs were tested in trials with only 8-12 weeks treatment period, so the adverse events collected and reported are those occurd during those few weeks only. While withdrawl usually starts some days/weeks AFTER the last dose so most of those were not reported, as for the immediate drug reaction, those should be collected and reported.

 

The post market adverse events are supposedly reported if they are serious, and reporting is solely based on patients and/or doctors. I doubt many ( even the ones in this forum with most severe and serious events) ever report.

 

Drug companies are required to update the drug insert/labeling from the post market reported serious adverse events. That's all.

"Drug companies are required to update the drug insert/labeling from the post market reported serious adverse events. That's all. "

 

If you take a look at the updates on the FDA website which I spent a lot of time doing in the last ten years... you will find a lot of them seem to get updated when the drug goes off patent.

 

For Effexor last time I looked pages of updates... some warning letter for marketing rules that were broken. If you check for symptoms for reactions they are very late if you compare them to the scientific studies.  It is an important issue... once the side effect is added to the drug list at the FDA you are then considered to be told of the risk...

 

once you are told of the risk you are then prevented from suing for damages.....

 

how many sick people check the FDA website for updates on drug reactions... how many... none that is how many .. drug stores in Canada need to post only the three most common side effect of a drug...

 

to this day for effexor these are

Nauseadrowsinessdizzinessdry mouth

 

for some reason all doctors seem to tell me about was dry mouth... 

knowing what I do now this is ridiculous, for our wellbeing but works well for them. 

 

I find it odd how little difference the black box warning made to consumption of the drugs ...after reading the minutes from the hearing that had that warning placed on the drugs and at what cost was to so many people... 

 

I think people don't take the bbw seriously if the drug was that bad they expect it to not be on the market... which is exactly what the people at the hearings were hoping for... these drugs to be pulled from the market. 

 

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There was  a lot of hope in 2004 that things would change... you can read it too I think history is important...

 

SSRI Experts Head to Washington to Testify Before ... - Baum Hedlund
Dec 13, 2006 - At that particular hearing, the famous SSRI litigator concluded her testimony ... 2004 hearings, Ms Menzies met with members of Congress to discuss .... "If you look at the transcript of the FDA hearing on this very side effect 10 

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Hats off to anyone who can find it I tried and can't...

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