Posted by Amelia_in_StPaul on June 23, 2009, at 11:55:00
In reply to Re: Sigh. Abilify is now prescribed. What about Luvox? » Amelia_in_StPaul, posted by emme on June 23, 2009, at 5:04:59
Yes, I have had genetic testing, from Mayo. But actually, anyone could've guessed based on my response patterns to medicine. My pdoc at the time suspected the problem, sent me for the test, and explained the report--although with any amount of intellect, one can read the tests, read studies and research into these genetic mutations and polymorphisms, and figure this out.
Yes, in theory, being an IM (intermediate metabolizer) might mean that I would benefit from pea-sized doses, depending on the AD. If you are talking about a medicine like Prozac that BOTH inhibits 2D6 and is then metabolized by it, then no. A drug that inhibits an intermediate metabolizer renders that person a poor metabolizer = stay the h$ll away from the drug. Because essentially, Prozac is rendering ineffective the one allele I have that is correct, and yet is trying to get metabolized by that allele. I have allowed pdocs to put me back on it in the last year and a half because it is the one I have responded to, but true to the experience of an intermediate metabolizer, I eventually end up with overwhelming side effects. I suspected it before, after going off Prozac and feeling half-way normal, physically, but tested that out by going on for a period of 9 months and then off again, after becoming a zombie and feelign suicidal again. Yep, it was the Prozac.
Further, theoretically, an IM might be able to get by on smaller doses of a drug that, say, is metabolized by 2D6 but doesn't inhibit it--but it doesn't quite work that way in practice. I have been on smaller doses of meds, when I could get past the initial side effects, as I could with Prozac, and they don't work at a "sub-therapeutic" level. They don't quell my OCD, they don't dampen the depression. But when the medication is raised, it works for a bit and then the side effects become overwhelming.
"The intermediate metabolizers are a particularly tricky group, say some experts. They might feel positive results from a drug at first, but get sick over time as it slowly builds up in their bloodstream. But because they've been on the drug for weeks or months, they might not recognize their symptoms as an adverse reaction to it."
http://www.upstreambio.com/downloads/liver_success.pdfYeah. That's me. For 10 years I was sick on Prozac, and had no idea. 10 years. I get quite angry about it (though there's no one to get angry at--the pdocs didn't have the information, though I do think they could've listened to me better, trusted my intuition), because I have lost a lot of opportunities from sleeping 12 hours a night and feeling dead the whole day no matter how much sleep I was getting. A grant I won and then had to give back b/c I couldn't complete the work. A lucrative job I lost because the hour-long drive was killing me. Days I was too tired to write--days upon days upon days, until I am further behind than my peers. Not to mention how disorganized I was and am, how unfocused...all because I cannot take typical ADHD meds when I am already on an AD. Why? Because they are metabolized by 2D6 too. And when I take them with an AD, I get robobuzz--something kids actually try to achieve but which I find scary. It is essentially a saturation of the drugs--as though I had sniffed crushed stimulants--even though I had taken a small dose.
There are some drugs that aren't primarily metabolized by 2D6. Celexa, for instance. Which I tried. And it didn't work. Now I know why. Again rereading the report last night Apparently my polymorphisms = nonresponse to Celexa. Yay!
And what about Wellbutrin? Tried it by itself, without Prozac. I experienced a week of anxiety so bad I literally, literally, tried to climb the walls. So my pdoc told me to break it in half and try half a dose. Just as bad--actually worse, probably becuase you just aren't supposed to break up Wellbutrin. It spikes in your blood, that way. I don't know why the reaction to Wellbutrin, but Mayo is careful to say that not all polymorphisms and mutations are detected. There are other routes of metabolization that Mayo has not yet been able to test. I could be a poor metabolizer or intermediate metabolizer of those too.
All I know is I feel frustrated. My genetic profile is not making it easy for me to find and stay on drugs.
> > One, because I have a genetic mutation that means I don't metabolize drugs well that use P450 2D6.
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> Just curious. How do you know this? Genetic testing? Also, when you say you don't metabolize those drugs well, does that mean a you have been advised by a doctor that you have a complete intolerance? Or might it mean that you would benefit by using hamster-sized doses?
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poster:Amelia_in_StPaul
thread:902046
URL: http://www.dr-bob.org/babble/20090620/msgs/902743.html