Posted by barbaracat on March 28, 2005, at 22:54:04
In reply to Mitch: Med Dose with Age, posted by smith562 on March 27, 2005, at 20:02:54
I've been thinking about Cytochrome P450 hepatic enzymes alot lately and wonder if many of us have genetic issues with drug detoxification. Cymbalta clears through isozymes CYP2D6 and CYP1A2. CYP2D6 is the big player in all antidepressant metabolism (other drugs as well, but across the board in ADs -- but not mood stabilizers). If something is going on that inhibits this enzyme, there's going to be alot more of the med circulating. This could be an interraction with other meds or foods, but perhaps it's more a genetic disorder. Perhaps bipolars have genetic abnormalities that interfere with metabolizing many of our naturally occurring chemicals?
Maybe these disorders show up later in life for some of us, and rather than high doses of ADs early on causing problems, it's more likely that we were able to clear them more efficiently then and not now. If bipolars either genetically, through drug interractions, food allergies, or for whatever other reason, experience CYP2D6 inhibition then it's no wonder we have nasty reactions to ADs. They're circulating much longer before clearing, a little goes a long way, and at the standard doses they give to unipolars - yikes!
This makes more sense to me than any theory on receptor disregulation or anything due to neuronal damage. Now that we know that neurons regenerate (thank God, thought I was stuck with my lot), I trust there's been enough turnover since when I 'damaged' them with high doses.
A genetic bipolar relationship with inhibition of metabolic enzymes breaks down somewhat on why the symptoms would be cyclically occurring. For instance, it would make sense if adrenaline clearance was inhibited, causing excessive anxiety with the resultant depressive crash, i.e., classic bipolar. But you'd expect this to be a contstant state and not have periods of normalcy in between. So any thoughts would be appreciated.
I am still getting a very positive response, now up to 13 pellets. Figure I'll stay at that number a while for good luck. - Barbara
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> I have been following your and B-Cats posts on taking "micro" doses cymbalta. I have seen/heard many individual talk about taking hefty to normal size antidepressant doses when they were younger .... now only to require "micro" dose or no ads as they get older. My question is do you think individuals with bipolar or bipolar spectrum illness tend to require less antidepressant with age?
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> If *yes*, is this due to kindling and the solidification of bipolarness (or another way to put it increasing sensitivity to ads as bipolar tendency concrete) .... or that as hormone levels decrease with age, one needs less ad? Thanks.
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> Smith
poster:barbaracat
thread:476412
URL: http://www.dr-bob.org/babble/20050326/msgs/476991.html