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Genetic testing: "Personalized medicine," liver enzymes, genotypes, GeneSightRx, Genomind, etc.


Razzle

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Conceivably, yes.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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Yes, the CYP450 collection of liver enzymes is about as important as it gets in the speed of metabolism of everything we consume.

 

So foods and drugs can be classified as inducers or inhibitors of this collection of enzymes which means they either speed up (induce) the metabolism of the consumed product, or slow down (inhibit) the consumed product.

 

A good table in English of foods and drugs classified as inducers or inhibitors is done by Edmund Hayes. It doesn't have everything, but it's pretty comprehensive.

 

The website is www.edhayes.com/startp450.html. This page give a good explanation of what the CYP450 liver enzymes do, and table 4 at the bottom of that page gives that comprehensive list of food and drugs that induce and/or inhibit the enzymes. That table is available by clicking on the table 4 link or at website www.edhayes.com/CYP450-4.html.

 

Marie

On Xanax 10 years for anxiety, 2 mgs, night only. Attempted my own taper w/o understanding the dependency issues.

 

Researched and then understood the need for longer half life med. Doctor crossed me from X to klonopin 4 times in 6 months. Last time on X, she up dosed me to 3 mgs X.

 

On last cross attempt, ended up in ER with profound w/d sx from X. Got new doctor. Final cross to K, structured, slow was completed 6/5/12-12/5/12.

 

Attempting liquid micro taper from K. Difficulty with micro cuts; significant w/d sx requiring several weeks of holding after each cut. Also concerned if it's possible to use pill/liquid combo for dosing.

 

Hope I Meet Other Benzo Taperers Here! I have tried ADs in past. Could not tolerate them, gave up trying, none for over 12 years.

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  • 4 months later...

I just received results of this test done at a university psych department. It turns out it was not my imagination that serotonergic drugs that I took for over 15 years had no positive effect on me.

1). I have a duplicate of the CYP2D6 allele, making me an ULTRA RAPID METABOLIZER and "may not be able to achieve clinical response using usual drug dosages."

 

Also,

 

2) LOW ACTIVITY on the SEROTONIN TRANSPORTER GENE (SERT, I think).... "patient may experience a delayed response with SSRIs, or may benefit from non-selective antidepressants".

 

I am NOT suggesting that everyone get this test because all of the other dangers of these drugs still exist. Just posting my results.

 

ETA: Just as an FYI... this test also checked for MTHFR polymorphisms but only the 677 allele. It did not check the 1298c allele which I know I have a polymorphism from a previous test.

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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Hi Barb, I also had this test, and was an ultra-metabolizer for the same CYP450 isoenzyme. It is strange though that I have taken several drugs metabolized through that pathway that I definitely had an effect from. But I think taking an inhibitor of that system, Wellbutrin, really messed with my liver. That little strand is probably the only thing in my being that works fast, and Wellbutrin slowed it down!

 

I was also heterozygous on SERT...my report said it could cause decreased tolerance for stress, and increased adverse effects from SSRIs. But one site I read said 40% of people of Euopean descent are heterozygous, 17% homozygous, so....?

 

I think they are still learning new stuff about the "other" MTHFR gene. Did the doc have any hopeful suggestions?

1st round Prozac 1989/90, clear depression symptoms. 2nd round Prozac started 1999 when admitted to dr. I was tired. Prozac pooped out, switch to Cymbalta 3/2006. Diagnosed with bipolar disorder due to mania 6/2006--then I was taken abruptly off Cymbalta and didn't know I had SSRI withdrawal. Lots of meds for my intractable "bipolar" symptoms.

Zyprexa started about 9/06, mostly 5mg. Tapered 4/12 through12/29/12

Wellbutrin. XL 300 mg started 1/07, tapered 1/18/13 through 7/8/13

Oxazepam mostly continuously since 6/06, 30mg since 12/12, tapered 1.17.14 through 8.26.15

11/06 Lithium 600mg twice daily, 2.2.14 400mg TID DIY liquid, 2.12.14 1150mg, 3.2.14 1100mg, 3.18.14 1075mg, 4/14 updose to 1100mg, 6.1.14 900 mg capsules 7.8.14 810mg, 8.17.14 725mg, 8.24.24 700mg...10.22.14 487.5mg, 3.9.15 475mg, 4.1.15 462.5mg 4.21.15 450mg 8.11.15 375mg, 11.28.15 362.5mg, back to 375mg four days later, 3.4.16 updose to 475 (too much going on to risk trouble)

9/4/13 Toprol-XL 25mg daily for sudden hypertension, tapered 11.12.13 through 5.3.14, last 10 days or so switched to atenolol

7.4.14 Started Walsh Protocol

56 years old

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Rapid metabolizers are at great risk for iatrogenic drug damage because, when they don't have any response to the drugs, doctors pile more drugs on them, causing drug-drug interactions and liver and kidney overload.

 

Poor metabolizers, on the other hand, soon suffer damage from lower doses.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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I just wanted to pop on and say that I DID have this test run and my insurance paid for it thankfully (it's ridiculously expensive).  Anyhow, the reaction I had to Zoloft was quickly explained by Zoloft showing up in the "Red" for me. Green = Good, Yellow = Maybe, Red = No No.

 

Pristiq was in the green, so they went with that. It wasn't bad really, I just could never relax my stomach as it was constantly in knots. If it wasn't for that, I'd probably have never stopped taking it...

Jan - Zoloft 50mg (no titrating, cold turkey, severe allergic reaction)

Feb - Vybriid 10mg (Only lasted 3 days on this stuff)

Mar - Amitriptyline 10mg (Landed me in the ER with some serious Tachycardia, stopped at two weeks)

Apr-June - Pristiq 50mg (9 weeks)

June 10 - Started Prozac 10mg

June 16 - Last dose of Pristiq 50mg with no taper

June 26 - Prozac increased to 20mg to help with discontinuation with a plan to taper down once stabilized.

July 1 - Pdoc concluded that while the discontinuation is unpleasant, it will not last forever and there was no need to change the dose of Prozac back down to 10mg. She confirmed that this reaction is not common, but is definitely a result of the Pristiq discontinuation and not a return of depression. (Guess that's good news!)

July 4 - Back up to 1mg Xanax per day at .25mg every 6 hours

July 8 - Drop to Prozac 5mg


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These tests show what drugs your liver can and can't metabolize. They do not indicate whether you might get other adverse effects from the "approved" drugs.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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Since I am still considering surgery, I was thinking it might be helpful to get tested for adverse reactions to drugs.   How would I go about this?  Do I need a doctor's order or can I do this on my own and if so, where would be a good place to go to?

 

Thanks!

Drug cocktail 1995 - 2010
Started taper of Adderall, Wellbutrin XL, Remeron, and Doxepin in 2006
Finished taper on June 10, 2010

Temazepam on a PRN basis approximately twice a month - 2014 to 2016

Beginning in 2017 - Consumption increased to about two times per week

April 2017 - Increased to taking it full time for insomnia

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Yes, it exists, actually they sometimes use them in court cases to prove a person's actions were due to a drug.  I researched this a while ago.  I know there's a lab called Genelex that people were using to have the tests done.  In all probability though there are other places now, as I heard recently the tests have come down in price and that they are starting to distribute them more widely (in my country at least.)  I haven't had it done so I don't know if Genelex would be the best place to go, or the cheapest if you have to pay (it was fairly expensive a number of years ago), so do some shopping if you are going to try it.

 

Also, one thing to be aware of-- I read somewhere that the tests do have limitations.  If what I read was correct, it appears that there are some situations  that they might not catch.  Of course, it sounds like they really do weed out at least some possible adverse reactions, so they may well be better than nothing.  However, what I read said that factors like age, a person's health status, what drugs they were taking, etc...could also affect their ability to digest a drug and the article implied the tests would not be able to rule out all drug reactions because of those factors.  It would be prudent then to find out just how reliable they are.  I don't know if they'd know this but the obvious concern would be-would they be able to rule out all possible reactions that might occur because of withdrawal sensitivities?  I really don't know what the answer would be.

I am not a medical professional and nothing I say is a medical opinion or meant to be medical advice, please seek a competent and trusted medical professional to consult for all medical decisions.

 

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CS,

 

I recently had a genetic profile done that shows how I metabolise drugs. Though this is not to predict adverse reactions, it may be of some value to you.

 

It showed that I am an ultra rapid metabolizer of drugs processed thru the CYP2D6 liver enzyme (probably the most common pathway...not sure). My body essentially can't use those drugs or would need mega doses. I also have an abnormality of the SERT serotonin transporter gene, making serotonin drugs ineffective for me.

 

Some people are slow metabolizers and -- I suspect -- might be predisposed to drug toxicity, possibly adverse events such as serotonin syndrome.

 

There is a thread about this GeneSightRx. The test is NOT geared toward side effects, but may have some value to you. Of course, this is just one small piece of the puzzle.

 

Hopefully Alto will correct any misinformation ive stated.

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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These are the liver enzyme tests. They're quite the fad lately, and their usefulness is exaggerated.

 

They will indicate which drugs your liver might have difficulty metabolizing. That's all. They do not indicate which drugs will be effective, and they do not indicate which drugs will cause adverse effects that are not related to liver metabolism.

 

Let us also be absolutely clear about this:

 

Many drugs, particularly many psychiatric drugs, are metabolized through these liver enzymes BUT

 

NOT ALL DRUGS ARE METABOLIZED THROUGH THE LIVER

 

At best, these tests apply to only a subset of drugs that are metabolized through the liver. Drugs can still have adverse effects that have nothing to do with the way they are metabolized.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Alto and Barb, thank you for your posts as they are very helpful. 

 

CS

Drug cocktail 1995 - 2010
Started taper of Adderall, Wellbutrin XL, Remeron, and Doxepin in 2006
Finished taper on June 10, 2010

Temazepam on a PRN basis approximately twice a month - 2014 to 2016

Beginning in 2017 - Consumption increased to about two times per week

April 2017 - Increased to taking it full time for insomnia

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  • 4 weeks later...
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Here's an explanation of the types of genetic testing psychiatrists might order http://www.psychcongress.com/blogs/chris-bojrab-md/genetic-testing-clinical-practice-what-psychiatrists-need-know

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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It's  not folic acid that compensates for MTHFR polymorphisms, it's FOLATE, and a very special kind. See http://mthfr.net/l-methylfolate-methylfolate-5-mthf/2012/04/05/

 

To sum up, look for

  • L-5-MTHF = L-5-Methyltetrahydrofolate = 6(S)-L-MTHF = 6(S)-L-Methyltetrahydrofolate
  • L-Methylfolate Calcium = Metafolin = Levomefolic Acid (brand name Metafolin)
  • (6S)-5-methyltetrahydrofolate (brand name Quatrefolic)
  • The labeling must specify the L form (or 6(S) form) of methylfolate
  • Avoid D-5-MTHF = D-5-Methyltetrahydrofolate = 6®-L-MTHF = 6®-L-Methyltetrahydrofolate -- the D form or 6® form of methylfolate

 

The forms of methylfolate that are biologically active are:

  • L forms
  • 6(S) forms
  • L-5 forms
  • Metafolin
  • L-Methylfolate Calcium
  • Levomefolic Acid
  • Quatrefolic

 

 

 

Folic acid rather than folate causes problems for people with MTHFR polymorphisms (up to 50% of the population) because they lack the enzyme to metabolize folic acid to folate and develop folate deficiency.

 

The doc who did this test for me gave me a bottle of Active B12 with L-5 MTHF  (folate - 800 mcg and B12 1000 mcg) 

 

i havent taken it because i dont want to have a reaction.  do you think i should try it - maybe after i even out a bit more?

 

i did the genomind testing because she offered it at no cost. i guess they are building up a database. 

it is all way above my head but interesting nonetheless.  not sure there is anything useful for tapering off the medication that i should never have taken in the first place!

 

P

not sure what use it was for me at this point except to confirm that an SSRI was not a good idea since i am a rapid metabolizer.

 

7 yrs Lexapro 10 mg. Mar/2011 - 1 month taper. Severe W/D. Multiple symptoms.Gallbladder and parathyroid surgery in Aug and Oct. Disability 3 months.  Dec/2011 reinstated 5mg Lex and went back to work. very bad shape.

By Aug/2012 - self tapered to 1.25 mg cutting pills. -very bad shape. Nov/2012  Dr. Hinz neuro-replete. up and down. Aug/2013 at aprox 1.0 mg Lex stopped neuro-replete ~Oct 2013 Found this site  ~ began using compounded Lexapro and have been micro tapering since then and holding as needed.

11/6/2013 -  0.6 mg

2/1/2018 - .135 mg  Now reducing 5-10% per month 

4/1/18 - .1 mg

4/17/18 - changed delivery from compounded individual caps to aliquot. went from .1 mg to .09 aliquot

7/4/2018 - .09 mg Holding due to wave of W/D symptoms

7/22/18 updosed to .1 mg aliquot

9/30/18 - reduced to .0975 aliquot

2/1/19 - updosed to .1 mg aliquot due to instability bad wave W/D

9/12/19 - back to .1 mg individual caps since could not get stable using aliquot

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As B vitamins, including B12 and folate, can be activating, I would try any B vitamins very, very cautiously, perhaps a tiny crumb each day for a few days so you can see how it affects you. Titrate up by very small amounts.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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thanks, Alto - intuition tells me to wait on experimenting with this. i will let you know if i do try it.

 

P

7 yrs Lexapro 10 mg. Mar/2011 - 1 month taper. Severe W/D. Multiple symptoms.Gallbladder and parathyroid surgery in Aug and Oct. Disability 3 months.  Dec/2011 reinstated 5mg Lex and went back to work. very bad shape.

By Aug/2012 - self tapered to 1.25 mg cutting pills. -very bad shape. Nov/2012  Dr. Hinz neuro-replete. up and down. Aug/2013 at aprox 1.0 mg Lex stopped neuro-replete ~Oct 2013 Found this site  ~ began using compounded Lexapro and have been micro tapering since then and holding as needed.

11/6/2013 -  0.6 mg

2/1/2018 - .135 mg  Now reducing 5-10% per month 

4/1/18 - .1 mg

4/17/18 - changed delivery from compounded individual caps to aliquot. went from .1 mg to .09 aliquot

7/4/2018 - .09 mg Holding due to wave of W/D symptoms

7/22/18 updosed to .1 mg aliquot

9/30/18 - reduced to .0975 aliquot

2/1/19 - updosed to .1 mg aliquot due to instability bad wave W/D

9/12/19 - back to .1 mg individual caps since could not get stable using aliquot

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I find it interesting that the few people here who had the genetic /liver enzyme test are all rapid or ultra rapid metabolizers at CYP2D6.

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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My cyp 2D6 was normal.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • 2 months later...

Can we have a discussion on this?  I googled Surviving Antidepressants and genomind, but could not find many direct references.  One of my doctors wanted me to do this saliva test to see which AD I would tolerate best or worst or I guess which ones I metabolize best or would have the least side effects from.  Not real clear on the purpose or how it would actually help direct what med to go on.

 

Why did they offer it to me at no charge????  Sounds suspicious.  Since this is a genetic test, I don't feel comfortable having my genetic data on some database.  Seems the offer of no charge is to build a database on people?  I declined the test.

 

If there is something to it, that would be helpful so people are not put on meds that they are sensitive to. 

 

Who knows more about this?  Thanks.

2002? zoloft.  Start of synthroid unknown.

2002? switched to paxil  - Developed restless leg syndrome. stopped all caffeine which helped for many years.

2003? switched to effexor XL 75 mg. May 2012 began taper

July 2012 stopped all effexor . Usual WD symptoms, lost excess weight, had more energy. RLS stopped immediately!

Sept 2012 depression off and on, increasing. Tried tryptophan and acupuncture

Dec 2012 severe anxiety began

February 2013 used magnolia bark for anxiety - helped but developed central sleep apnea, so I stopped it

by April 2013- stopped tryptophan, using saffron herb successfully and started HRT

June 2013 doctor noticed bradycardia. I tried very small dose cytomel sev days for hypothyroidism but seemed to strain my heart.

July 2013 stopped saffron due to slow heart and palpitations - did not help.

July 2013 Increased synthroid from 50mg to 75mg. depression and anxiety improved. Heart problems continue.

September & October 2013 - 2 month course of antibiotic for possbile lyme disease - mood and anxiety improved further.  Heart pvc's flair up at times. 

 

 

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My current doc has all pts. do it, at no charge to pt. The good thing for me is that she ended up saying, "I don't think meds are ever going to work for you," thereby ending one conflict:). It can raise red flags about classes of drugs, especially SSRI's, being unlikely to be effective, and more prone to adverse effects, via the SERT gene. One gene is linked to more-risk-than-usual for metabolic problems with antipsychotics. It tests for some other genes that increase risk of mental illness. It looks at some SNP's from the MTHFR and COMT portion of the methylation cycle. Then it looks at how efficient different subtypes of liver enzymes are, particularly those involved in many psych meds. That does not predict adverse effects, but it can warn of risk of toxic levels or unpredictable levels. I have taken many drugs and I have two unusual enzymes, but I didn't notice anything different about the metabolism of drugs that went through it. I think normal cost is about $600, definitely not worth it, but "free" was worth it. If you want genetic testing on your health, you could get more bang for your buck elsewhere as this is very drug focused.

1st round Prozac 1989/90, clear depression symptoms. 2nd round Prozac started 1999 when admitted to dr. I was tired. Prozac pooped out, switch to Cymbalta 3/2006. Diagnosed with bipolar disorder due to mania 6/2006--then I was taken abruptly off Cymbalta and didn't know I had SSRI withdrawal. Lots of meds for my intractable "bipolar" symptoms.

Zyprexa started about 9/06, mostly 5mg. Tapered 4/12 through12/29/12

Wellbutrin. XL 300 mg started 1/07, tapered 1/18/13 through 7/8/13

Oxazepam mostly continuously since 6/06, 30mg since 12/12, tapered 1.17.14 through 8.26.15

11/06 Lithium 600mg twice daily, 2.2.14 400mg TID DIY liquid, 2.12.14 1150mg, 3.2.14 1100mg, 3.18.14 1075mg, 4/14 updose to 1100mg, 6.1.14 900 mg capsules 7.8.14 810mg, 8.17.14 725mg, 8.24.24 700mg...10.22.14 487.5mg, 3.9.15 475mg, 4.1.15 462.5mg 4.21.15 450mg 8.11.15 375mg, 11.28.15 362.5mg, back to 375mg four days later, 3.4.16 updose to 475 (too much going on to risk trouble)

9/4/13 Toprol-XL 25mg daily for sudden hypertension, tapered 11.12.13 through 5.3.14, last 10 days or so switched to atenolol

7.4.14 Started Walsh Protocol

56 years old

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Hi Janie,

 

I am sure others can explain it alot better than me but you were right to decline the testing.  In looking at this article, http://www.bizjournals.com/philadelphia/print-edition/2012/06/08/genomind-to-personalize-depression-drugs.html?page=all, I came upon this exert:

 

 

Psychiatric disorders are not heterogenous,” Lombard said. “It’s not one size fits all” when treating such conditions. “If, for example, the patient’s test shows the person [suffering from depression] is not producing enough dopamine, the doctor could choose a drug that stimulates the production of dopamine.”

It looks like they are perpetuating the old stereotypical myth that depression is based on a chemical imbalance if they can just find what you are difficient in. Obviously, this is another crock of you know what, as voila, your miracle drug will be found.

 

A big fat sigh!

Drug cocktail 1995 - 2010
Started taper of Adderall, Wellbutrin XL, Remeron, and Doxepin in 2006
Finished taper on June 10, 2010

Temazepam on a PRN basis approximately twice a month - 2014 to 2016

Beginning in 2017 - Consumption increased to about two times per week

April 2017 - Increased to taking it full time for insomnia

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It should be malpractice not to.  I did Genomind and it does not tell you what neurotransmitters you are deficient in.  It will tell you how you metabolize the different drug pathways (CYP2D6, CYP2C19, and CYP3A4/5, etc.)  It will also tell you whether you have a genetic polymorphism in your serotonin transporter gene (SLC6A4).  These tests alone are worth their weight in gold.  It also tests for other genetic issues which are predictors of AD response.  Is it magic? No.  But I would not want to enter into the world of psychiatric drugs without having a clue which ones might cause problems.

 

For example, let's say you are poor metabolizer of C19…that will rule out Celexa, Lexapro and Diazapam as effective treatment options with risk of adverse events.  If you carry the short arm allele of SLC6A4 then it means that SSRIs are unlikely to work and more likely to create adverse events.  It will also tell your Dr if dose adjustments are needed as well.  If you over-metabolize an enzyme you might need a higher dose and vice versa.  

 

You get the idea.  Why experiment with 3 or 4 different medications for weeks on end when your genetic markers would have given you the warning signs?

2013 Jan-Mar (12 weeks) Cymbalta 60mg (way too activating)2013 Apr-May (8 weeks) Pristiq 50mg (partial response)2013 Jun-Aug (12 weeks) Lexapro (can't remember dose); caused muscle and joint painSep 13 to Jan 14 (20 weeks) Back to Prsitiq, muscle pain subsides but drug not working2014 Feb - Mar (8 weeks) Celexa 10mg (not even therapeutic dose), killed all depression and anxiety within 1 week but severe pain started within 5 days in back and lower extremities.2014 April (4 weeks) Effexor, worked like Celexa seamless transition, pain continuesThere was some Gabapentin, Buspar, Propranalol tossed there from time to time as well that did nothing.<p>Switched to Cymbalta 30mg on April 17. Dr directed stop on May 7th. I went down to 15mg within a week and felt OK, then to 10mg for 5 days and stopped.

Current Meds: 5-10mg Ambien, 1.5MG Xanax XR in 3 divided doses of .5MG each.  25mg Seroquel as a rescue drug for sleep.

 

Supplements:  Fish Oil, combination of Theratears Nutrition (designed for dry eye and is recommend by my ophthalmologist) and Arctic Pure.  Total EPA and DHA are 1540mg spilt between AM and PM.  NutNCology Magnesium Citrate, 170mg in the evening.  Twinlabs B-12 sublingual Dots, 500mcg (AM).

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thanks for your comments.  It sounds like there are different opinions on this, but there might be something to it.  I don't understand why the doctors will do it for free.  Apparently Genomind gives some complimentary tests to doctors - maybe X number per month?  What is in it for them to do that?  I feel there is a data mining operation going on .  Although the doc said no charge, when I went to sign the order form it said they would charge my insurance.  From what I've read there are dangers in having insurance know your genetic makeup.  I think I read that there is a law that your employer cannot discriminate on genetic makeup , but there is no law that the insurance company can discriminate and not cover a treatment based on your genetics.  Things my be different with the new Affordable healthcare act that would prevent such practice by an insurance provider. however I am still suspicious about a $600 test being offered for free.

 

I don't want my insurance to be charged. I don't want to have part of my deductible go towards this test. I guess it MIGHT be helpful if you intended to take an AD but I really don't want to ever take one anyway.  If I feel I must, then maybe this test will be important to avoid certain meds that would be harmful (more than others - they are all harmful).

 

do we on this site believe chemicals have no effect on the brain? We discuss gut flora helping the brain, we know neurotransmitters exits, but we deny that such chemicals or lack thereof can affect mood? sorry but I do believe in chemical imbalance to a degree. We all know the benefit of endorphins from exercise. I also believe when you are loved and supported your body creates the good chemicals naturally. I know I feel better after talking to someone about my problems and feeling they care and support me.  the physical symptoms of anxiety can disappear after a good talk therapy session. I know  this is a whole other discussion I should post separately.

2002? zoloft.  Start of synthroid unknown.

2002? switched to paxil  - Developed restless leg syndrome. stopped all caffeine which helped for many years.

2003? switched to effexor XL 75 mg. May 2012 began taper

July 2012 stopped all effexor . Usual WD symptoms, lost excess weight, had more energy. RLS stopped immediately!

Sept 2012 depression off and on, increasing. Tried tryptophan and acupuncture

Dec 2012 severe anxiety began

February 2013 used magnolia bark for anxiety - helped but developed central sleep apnea, so I stopped it

by April 2013- stopped tryptophan, using saffron herb successfully and started HRT

June 2013 doctor noticed bradycardia. I tried very small dose cytomel sev days for hypothyroidism but seemed to strain my heart.

July 2013 stopped saffron due to slow heart and palpitations - did not help.

July 2013 Increased synthroid from 50mg to 75mg. depression and anxiety improved. Heart problems continue.

September & October 2013 - 2 month course of antibiotic for possbile lyme disease - mood and anxiety improved further.  Heart pvc's flair up at times. 

 

 

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They accept what your insurance pays as payment in full, you do not have to pay the deductible. My guess is that they are "giving it away" in an attempt to make it part of mainstream treatment, which is what insurance pays for. If you are not intending to take meds, there is not really a need. For me, it stopped my new dr. from trying to give me new meds at every visit, and it reassured me that I do not have any of the genes commonly.known to be associated with bipolar/schizophrenia, but it could easily have gone the other way. I'm not sure I want to look under the engine much like that, but I can see the other side easily as well. I was beside myself with anxiety the day I did the test, in no shape to fight the dr. over declining it. Just getting out without Klonopin was an accomplishment! For me, not anyone else, I am virtually certain I have some other issues contributing to my symptoms besides withdrawal.

1st round Prozac 1989/90, clear depression symptoms. 2nd round Prozac started 1999 when admitted to dr. I was tired. Prozac pooped out, switch to Cymbalta 3/2006. Diagnosed with bipolar disorder due to mania 6/2006--then I was taken abruptly off Cymbalta and didn't know I had SSRI withdrawal. Lots of meds for my intractable "bipolar" symptoms.

Zyprexa started about 9/06, mostly 5mg. Tapered 4/12 through12/29/12

Wellbutrin. XL 300 mg started 1/07, tapered 1/18/13 through 7/8/13

Oxazepam mostly continuously since 6/06, 30mg since 12/12, tapered 1.17.14 through 8.26.15

11/06 Lithium 600mg twice daily, 2.2.14 400mg TID DIY liquid, 2.12.14 1150mg, 3.2.14 1100mg, 3.18.14 1075mg, 4/14 updose to 1100mg, 6.1.14 900 mg capsules 7.8.14 810mg, 8.17.14 725mg, 8.24.24 700mg...10.22.14 487.5mg, 3.9.15 475mg, 4.1.15 462.5mg 4.21.15 450mg 8.11.15 375mg, 11.28.15 362.5mg, back to 375mg four days later, 3.4.16 updose to 475 (too much going on to risk trouble)

9/4/13 Toprol-XL 25mg daily for sudden hypertension, tapered 11.12.13 through 5.3.14, last 10 days or so switched to atenolol

7.4.14 Started Walsh Protocol

56 years old

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There is no such thing as neurotransmitter deficiciencies per se and these tests don't tell you whether or not a drug will "work" for you. They just tell you whether or not you can metabolize it, is my understanding, or how you metabolize it. 

 

Yes of course neurotransmitters exist but whether or not there is such a thing as "imbalance" and whether or not that can be cured by drugs--with many studies and all the financial power of Big Pharma behind it, nobody has been able to show that there is such a thing as an "imbalance" of neurotransmitters. Neurotransmitters and neurohormones are constantly changing throughout all parts of the brain and body in a constant incredibly complex dance. They are totally involved in our emotions, thinking, everything we experience. 

 

But that's not a disease that needs to be fixed by drugs, and it's also way complex far beyond our understanding so any drug that messes with them is more likely to disrupt their function than to fix them. Meeting our human needs, on the other hand, is a great way to heal and support ourselves.

Started on Prozac and Xanax in 1992 for PTSD after an assault. One drug led to more, the usual story. Got sicker and sicker, but believed I needed the drugs for my "underlying disease". Long story...lost everything. Life savings, home, physical and mental health, relationships, friendships, ability to work, everything. Amitryptiline, Prozac, bupropion, buspirone, flurazepam, diazepam, alprazolam, Paxil, citalopram, lamotrigine, gabapentin...probably more I've forgotten. 

Started multidrug taper in Feb 2010.  Doing a very slow microtaper, down to low doses now and feeling SO much better, getting my old personality and my brain back! Able to work full time, have a full social life, and cope with stress better than ever. Not perfect, but much better. After 23 lost years. Big Pharma has a lot to answer for. And "medicine for profit" is just not a great idea.

 

Feb 15 2010:  300 mg Neurontin  200 Lamictal   10 Celexa      0.65 Xanax   and 5 mg Ambien 

Feb 10 2014:   62 Lamictal    1.1 Celexa         0.135 Xanax    1.8 Valium

Feb 10 2015:   50 Lamictal      0.875 Celexa    0.11 Xanax      1.5 Valium

Feb 15 2016:   47.5 Lamictal   0.75 Celexa      0.0875 Xanax    1.42 Valium    

2/12/20             12                       0.045               0.007                   1 

May 2021            7                       0.01                  0.0037                1

Feb 2022            6                      0!!!                     0.00167               0.98                2.5 mg Ambien

Oct 2022       4.5 mg Lamictal    (off Celexa, off Xanax)   0.95 Valium    Ambien, 1/4 to 1/2 of a 5 mg tablet 

 

I'm not a doctor. Any advice I give is just my civilian opinion.

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Yes, Janie, of course chemicals affect the body, brain, and nervous system. They can also affect mood.

 

There are many chemicals that affect mood; arsenic, carbon monoxide, estrogen, food poisoning, alcohol, amphetamine, LSD, marijuana, and MDMA among them.

 

That chemicals i.e. psychiatric drugs correct a "chemical imbalance" has definitively been demonstrated to be a myth. If you want to believe it anyway, that's your choice.

 

Statistical analysis demonstrates that psychiatric drugs do not have predictably beneficial results. Roughly a third of all subjects in clinical trials drop out because of intolerable adverse effects. This means there is a segment of the population upon which the drugs were never even tested. Of the ones that remained, about a third experienced effects they interpreted as beneficial, about a third detrimental, and about a third no effect at all -- what you would expect from a substance that's not any more effective than placebo.

 

However, if you wish to believe a pill will fix you, you are free to believe that, too.

 

As for these genetic tests: They may indicate which drugs may cause a certain type of adverse reaction. The tests do not indicate which drugs will "work."

 

At best, the tests will help some people avoid certain drugs that are likely to cause an adverse reaction, but they do not eliminate the possibility of an adverse reaction -- there are other kinds of adverse reactions unrelated to these particular tests.

 

There's a big fad for these tests right now, with doctors misinforming patients the tests show which drugs will be effective. It may be Genomind is giving away tests now to build a customer base among doctors.

 

However, do not assume because your doctor has the test results, he or she will prescribe a drug that has no side effects or one that will solve your problems.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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thank you all for the explanations and clarifications.  all I know is that I am messed up and I am worse off after stopping meds than before I got on them. of course if I have lyme disease that is another factor messing me up.   I guess what I'm understanding you are saying is chemicals exist in varying quantities in the body and brain. chemicals affect mood.   'chemical imbalance' may refer to undesirable moods. But medications do not correct imbalances or undesirable moods or undesirable mental states.  If they sometimes appear to, then it is due to the placebo affect.

2002? zoloft.  Start of synthroid unknown.

2002? switched to paxil  - Developed restless leg syndrome. stopped all caffeine which helped for many years.

2003? switched to effexor XL 75 mg. May 2012 began taper

July 2012 stopped all effexor . Usual WD symptoms, lost excess weight, had more energy. RLS stopped immediately!

Sept 2012 depression off and on, increasing. Tried tryptophan and acupuncture

Dec 2012 severe anxiety began

February 2013 used magnolia bark for anxiety - helped but developed central sleep apnea, so I stopped it

by April 2013- stopped tryptophan, using saffron herb successfully and started HRT

June 2013 doctor noticed bradycardia. I tried very small dose cytomel sev days for hypothyroidism but seemed to strain my heart.

July 2013 stopped saffron due to slow heart and palpitations - did not help.

July 2013 Increased synthroid from 50mg to 75mg. depression and anxiety improved. Heart problems continue.

September & October 2013 - 2 month course of antibiotic for possbile lyme disease - mood and anxiety improved further.  Heart pvc's flair up at times. 

 

 

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A "chemical imbalance" is not responsible for undesirable moods. A range of moods is normal. A lot of things affect moods, most prominently your thoughts and experiences.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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  • 5 months later...

This is where I'm confused,  do you agree  5htp/ tryptophan and tyrosine make changes to the brain.

when we say someone is deficient in serotonin or dopamine or we increase levels and see a change in behaviour, is that all bunk ?

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Psychoactive substances of every variety affect the brain. They can be stimulating, soporific, euphoric, etc. They don't "balance" anything.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • 4 months later...

Hi All,

 

I'm wondering if anyone else has gotten genetic testing done and is a poor serotonin transporter? I read that the genotype makes coming off ssris very difficult.

 

Best,

Ky

Zoloft from 2006-2014.

Suffered hypomanic episode in 2014 and tried a multitude of meds.

Ended up on low dose Prozac for 1 month.

Currently withdrawing off of Prozac.

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Please explain further what you mean by a poor serotonin transporter and what tests show this.

 

Also, please provide references for "I read that the genotype makes coming off ssris very difficult."

 

(My guess is you're thinking of poor metabolizers via liver enzyme testing and generic P450 cytochrome typing. This has nothing to do with difficulty going off SSRIs. It is related to adverse effects while you're taking an SSRI.)

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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Hi Altostrata,

 

Sure! Companies such as Genomind and Youscript offer genetic testing to determine clinical response to antidepressants and help find the most effective medication.

 

http://genomind.com/the-science-behind-the-test/

 

The type of Serotonin Transporter we genetically carry is said to determine our response/sensitivity to SSRIs. " The LA allele expresses normal levels of the serotonin transporter, while the Long G (LG) and S alleles express lower levels. SLC6A4 (Serotonin Transporter).  Greater caution is recommended when initiating or discontinuing SSRIs in individuals with the LG or S alleles." I'm an S/S (poorest of transporters) and literally lose my mind with the slightest drop in an SSRI. Was wondering if anyone else got tested.

 

 

EXPLANATION BELOW:

 

http://www.suregenetest.com/Clinicians/GenesTested.aspx

 

The molecular mechanism of antidepressant drug action involves inhibition of the neuronal serotonin transporter (SERT). SERT is encoded by the gene SLC6A4. One functional polymorphism in the regulatory region of this gene is a 44-base pair (bp) insertion/deletion resulting in a Long A (LA) promoter variant and a Short A (S) promoter variant, the latter resulting in two-fold decreased expression and transport activity in vitro.3 The LA allele expresses normal levels of the serotonin transporter, while the Long G (LG) and S alleles express lower levels. Several published studies have reported an enhanced therapeutic response to selective serotonin reuptake inhibitors (SSRIs) in LA homozygous patients (i.e.) patients carrying two LA alleles of the 44-bp insertion/deletion polymorphism in the regulatory region of SLC6A4, the gene encoding SERT.4 LA homozygous patients are designated as "SLC6A4 Normal Responders" and express normal levels of the serotonin transporter and also are reported to be more likely to respond to SSRI therapy within the first four weeks of treatment. Patients that carry only one copy of the LA allele are designated as "SLC6A4 Intermediate Responders." These patients have an increased risk of adverse events or delayed time to response when treated with SSRIs.4 Greater caution is recommended when initiating or discontinuing SSRIs in individuals with the LG or S alleles. Patients with S/S, S/LG, and LG/LG genotypes are designated as "SLC6A4Poor Responders" and may be less likely to achieve remission of depression, more likely to have a higher number of antidepressant trials, and more likely to experience adverse effects when treated with SSRIs compared to non-SSRI antidepressants.4

Zoloft from 2006-2014.

Suffered hypomanic episode in 2014 and tried a multitude of meds.

Ended up on low dose Prozac for 1 month.

Currently withdrawing off of Prozac.

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I was reading about this and wondering if I am ss only because my first anxiety attacks came when I was 8 years old- I wonder if I have a genetic predisposition to being insensitive to serotonin- I'm going to ask my doc to see if I can get a test for this- even if I am I still want off the meds-

 

*Currently at 8.2-8.5 mg of my 10mg pill of Paxil (they actually weigh 12.5mg) 

january 2023 I began reducing my med again. I was a 9mg weight for years, I went to 8.9 in January, went to 8.6mg in February, and in March 2023 I went down to 8.5-8.2 mg ( my scale varies, so I stick within that .3 range because of that) 

*No other supplements or vitamins 

*Taper schedule in the pdf 

Blank.pdf

 

https://docs.google.com/document/d/1-5vShtJtwAOGA30OxIP87steLmMdFzD29F0fzAPD564

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This is all well and good, testing for this, but unfortunately, the fact that 'increasing the level of one neurotransmitter (serotonin)' was bunk science promulgated by pharma to sell drugs and make obscene profits makes this a non starter and nothing to waste your money on, in my opinion.

 

The monoamine theory as a cause of depression is not a subject for discussion here at SA and that is what is at the base of this article. But if it were true, the genetic testing people will be just as rich as the pharma people very soon.

 

Don't waste your money. Either by giving it up to buy drugs OR to test for their purported efficacy (or non efficacy). Get over wd syndrome as best as you can, build your health back up and stay away from them for the rest of your life. I have had the worst depressions of my life while off those drugs (caused by those drugs manipulating my serotonin and norepinephrine, only 2 of the neurotransmitters) and I assure you, they are time limited and survivable, horrible as they may be.

 

Read Anatomy of an Epidemic by R. Whittaker and get yourself educated instead. You've bought into the hype if you are considering things like this for at their heart is money, not the betterment of mankind.

 

By the way, don't mind me. I am now anti drug all the way. Pretty pissed that with all of my education I was so soundly fooled for so many years. SSRIs are a fool's game played with your brain. Just say NO.

What happened and how I arrived here: http://survivingantidepressants.org/index.php?/topic/4243-cymbaltawithdrawal5600-introduction/#entry50878

 

July 2016 I have decided to leave my story here at SA unfinished. I have left my contact information in my profile for anyone who wishes to talk to me. I have a posting history spanning nearly 4 years and 3000+ posts all over the site.

 

Thank you to all who participated in my recovery. I'll miss talking to you but know that I'll be cheering you on from the sidelines, suffering and rejoicing with you in spirit, as you go on in your journey.

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Nobody is insensitive to serotonin. Serotonin is key to digestion. The gut is swimming with it, literally.

 

Please, let's stop discussing insensitivity to serotonin or serotonin deficiencies or imbalances. It's nonsense. Read this Again, chemical imbalance is a myth. Stop the lies, please.

 

The nervous systems of "poor serotonin transporters" do fine with whatever neurohormones they produce. The body is designed to keep hormonal levels at a steady state called "homeostasis." Psychiatric drugs perturb this homeostasis, substituting an artificial para-homeostasis that causes adverse effects.

 

nycdreamer, to my knowledge, no one has connected "poor serotonin transporter" to propensity to withdrawal syndrome. I would read the cautions about discontinuation in that quote to refer to danger of relapse.

 

Although the testing companies claim to help determine which medication is most "effective," what they really do is indicate which drugs are most likely to cause adverse effects. Among psychiatric drugs, "effective" is still a crap shoot.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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