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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Twinleaf on July 9, 2012, at 16:37:28
Even though I have been in remission for several years, my very up-to-date psychopharmacologist, who administers maintenance rTMS, suggested that I have genetic testing for gene variants associated with anxiety and depression. I gave a saliva sample, and the testing was covered almost completely by my insurance.
I have a variant from both parents which is associated with a poor response to SSRIs. I took them in large doses for about 8 years, and absolutely hated them!
I have a common variant which is weakly associated with bipolar disorder. I don't have that diagnosis, but I do respond well to medications like lithium and atypical antipsychotics.
I also have the Val/Val variation of COMT, which is associated with hypodopaminergic states in the prefrontal cortex. People with this are known to respond well to rTMS, as I do. Stimulants can help, too, although I have not tried any.
The testing is just in its infancy, and is sure to get more complex and helpful, but I feel I am on much more solid ground, and can make a much better treatment plan with my pdoc in case I relapse. And I have to emphasize how important good therapy has been , because of the strong elements of childhood trauma which I have.
So far, only two pdoc's in my city are known to do this, but...brave new world!
Posted by Phillipa on July 9, 2012, at 16:56:04
In reply to Genetic testing!, posted by Twinleaf on July 9, 2012, at 16:37:28
Twinleaf didn't know it existed. How does one get this testing done? Phillipa
Posted by Twinleaf on July 9, 2012, at 21:17:25
In reply to Genetic testing!, posted by Twinleaf on July 9, 2012, at 16:37:28
If you want to do it, you'll need to find a pdoc willing to order it for you. I should emphasize that everything about genetic testing falls into the category of " more likely" and "less likely"; it's not a way of definitively diagnosing anything. Still, it can make our choices of medications a bit more informed. I am really glad I did it.
Posted by linkadge on July 9, 2012, at 21:27:46
In reply to Genetic testing!, posted by Twinleaf on July 9, 2012, at 16:37:28
>I also have the Val/Val variation of COMT, which >is associated with hypodopaminergic states in >the prefrontal cortex. People with this are >known to respond well to rTMS, as I do. >Stimulants can help, too, although I have not >tried any.
Start drinking green tea and consuming quercetin. Both are COMT inhibitors. (Green tea also inhibits MAO-B and DAT).
Linkadge
Posted by linkadge on July 9, 2012, at 21:29:33
In reply to Re: Genetic testing!, posted by Twinleaf on July 9, 2012, at 21:17:25
Interesting.
He must be working though an independant lab? These tests are not typical.
Linkadge
Posted by linkadge on July 9, 2012, at 21:34:55
In reply to Genetic testing!, posted by Twinleaf on July 9, 2012, at 16:37:28
>I have a common variant which is weakly >associated with bipolar disorder. I don't have >that diagnosis, but I do respond well to >medications like lithium and atypical >antipsychotics.
Do you recall which one this was?Linkadge
Posted by Emily Elizabeth on July 9, 2012, at 21:41:40
In reply to Re: Genetic testing!, posted by linkadge on July 9, 2012, at 21:34:55
I keep in touch a little bit with my pdoc from my grad school days. She said that she has started using this sort of testing through a company called AssureRX. They have a website if you are interested. I personally haven't had the testing done because she hadn't started using it yet when we were working together. She says that it has been very useful in her practice.
Best,
EE
Posted by Twinleaf on July 9, 2012, at 21:54:18
In reply to Re: Genetic testing!, posted by linkadge on July 9, 2012, at 21:27:46
The variant for the weak association with bipolar is CACNA1C. He uses the Genomind Co. They are presently testing for 12 gene variations plus 3 liver enzymes. Even though it's new and not yet used very much, my insurance paid without any questions.
Good to know about the green tea - I actually drink a lot of it.
Posted by Twinleaf on July 9, 2012, at 21:58:12
In reply to Re: Genetic testing!, posted by Emily Elizabeth on July 9, 2012, at 21:41:40
That's good to hear. Even though the genetic testing deals only in probabilities, I got the same strong impression from my pdoc - that it is helping him make much more informed recommendations.
Posted by sigismund on July 9, 2012, at 22:14:54
In reply to Genetic testing!, posted by Twinleaf on July 9, 2012, at 16:37:28
>I also have the Val/Val variation of COMT, which is associated with hypodopaminergic states in the prefrontal cortex.
Was it you who responded well to tianeptine? I forget.
Posted by Twinleaf on July 9, 2012, at 22:45:50
In reply to Re: Genetic testing! » Twinleaf, posted by sigismund on July 9, 2012, at 22:14:54
Yes - that has been the best one. Unfortunately, not being produced in America, it isn't included in any of the "less likely" or "more likely" to help medication lists for each gene variant on the report I received.
Posted by Phillipa on July 9, 2012, at 23:25:29
In reply to Re: Genetic testing!, posted by Twinleaf on July 9, 2012, at 22:45:50
This is really good news. I will ask but knowing this old guy not likely. Phillipa
Posted by linkadge on July 10, 2012, at 15:06:27
In reply to Re: Genetic testing!, posted by Twinleaf on July 9, 2012, at 21:54:18
CACNA1C is involved in calcium channel function.
Have you had any sucess with something like gabapentin or verapamil? calcium channel blockers
Linkadge
Posted by Twinleaf on July 10, 2012, at 15:45:39
In reply to Re: Genetic testing!, posted by linkadge on July 10, 2012, at 15:06:27
No I haven't; what I'm doing now seems to be working pretty well. Good ideas just in case, though - thanks!
Posted by linkadge on July 10, 2012, at 19:18:45
In reply to Re: Genetic testing!, posted by Twinleaf on July 10, 2012, at 15:45:39
Yeah, lithium can be good for a few of those problems. Lithium will enhance serotonin reuptake if its too high and inhibit it if its too low. It also acts as a calcium channel blocker.
Linkadge
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