Posted by Mtom on August 29, 2018, at 9:57:47
In reply to Re: titrating slowly but anxiety increases. Thoughts?, posted by Christ_empowered on August 29, 2018, at 7:30:48
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 difference 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.
I don't like what I read about gabapentin for side effects.
It appears I will have to stick it through a few more weeks titrating slowly with escitalopram.
I am also looking into rTMS, but that is a whole other discussion.
> maybe antidepressants just aren't for you. what symptoms go with your depression? what other psych drugs have you tried?
>
> the 1st thought that came to my mind was gabapentin and a low dose 'atypical,' or perhaps even buspirone (buspar). just a thought...im clearly not prescribing to anybody, lol.
>
> antidepressants aren't a good fit for a lot of people.
poster:Mtom
thread:1100658
URL: http://www.dr-bob.org/babble/20180728/msgs/1100686.html