Posted by Mtom on August 29, 2018, at 15:58:21
Hi posted this to another thread but think it should be posted separately for discussion.
I currently take escitalopram. Have had adverse affects with all the AD's I've tried so far & interested in comments on Genetic Testing (would be great if Dr. Bob was able to weigh in with his opinion on these tests).
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 different 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.
Anyone delved into these Genetic tests in detail?
poster:Mtom
thread:1100696
URL: http://www.dr-bob.org/babble/20180728/msgs/1100696.html