Genetics & Reactions to Meds

[ahalo]

I don't know where to put this since it pretty much has to do with any medication, but I figured I would start here.  A lot of MI runs in families but not everyone gets treated; but for those of you who have family members with MI who have been treated, do you notice that medications work on you similarly, or "don't" work similarly? 

I found out last night that Cymbalta is the first and only medication that was able to break my mom out of a 5 year terrible spell of depression, suicidal idealizations, substance abuse, agoraphobia, the works...  SSRIs were either ineffective for her or worsened her symptoms.  That seems to be true for me as well-- Zoloft made me worse and Prozac had little effect besides weight loss.  Although with my mom Prozac was one that made her worse.  My brother is on Paxil and it has not been very effective for him.  In the past Prozac helped his OCD but worsened his anxiety/depression.

Both my mom and brother tried Wellbutrin and had a bad response; so did my half sister (unrelated to my mom) and I.  My half-sister has had her OCD symptoms alleviated by Lexapro and Luvox, but was very tired and lethargic on each of those meds.

Klonopin has helped both my mom and brother.  My mom had an awful reaciton to Zyprexa and Seroquel. I've taken Abilify at a very low dose and it has helped me sleep and seems to help with my anxiety?.  My mom has taken Trazodone for sleep and it helps her a lot; Lunesta helps my brother and has helped my half sister.

I'm just wondering if it is true that family members might have similar reactions to meds-- my half-sister has ADHD like I do as well as anxiety; my mom and brother tend to have severe depression on top of anxiety but no ADHD, they also have had substance abuse issues.  So I don't know if I would have similar luck on Cymbalta or Klonopin given that I've never been depressed.

Basically just wanting to compare with others if you have noticed any patterns between family members.  Thank you much!!

[jafco]

I don't know where to put this since it pretty much has to do with any medication, but I figured I would start here.  A lot of MI runs in families but not everyone gets treated; but for those of you who have family members with MI who have been treated, do you notice that medications work on you similarly, or "don't" work similarly? 

I found out last night that Cymbalta is the first and only medication that was able to break my mom out of a 5 year terrible spell of depression, suicidal idealizations, substance abuse, agoraphobia, the works...  SSRIs were either ineffective for her or worsened her symptoms.  That seems to be true for me as well-- Zoloft made me worse and Prozac had little effect besides weight loss.  Although with my mom Prozac was one that made her worse.  My brother is on Paxil and it has not been very effective for him.  In the past Prozac helped his OCD but worsened his anxiety/depression.

Both my mom and brother tried Wellbutrin and had a bad response; so did my half sister (unrelated to my mom) and I.  My half-sister has had her OCD symptoms alleviated by Lexapro and Luvox, but was very tired and lethargic on each of those meds.

Klonopin has helped both my mom and brother.  My mom had an awful reaciton to Zyprexa and Seroquel. I've taken Abilify at a very low dose and it has helped me sleep and seems to help with my anxiety?.  My mom has taken Trazodone for sleep and it helps her a lot; Lunesta helps my brother and has helped my half sister.

I'm just wondering if it is true that family members might have similar reactions to meds-- my half-sister has ADHD like I do as well as anxiety; my mom and brother tend to have severe depression on top of anxiety but no ADHD, they also have had substance abuse issues.  So I don't know if I would have similar luck on Cymbalta or Klonopin given that I've never been depressed.

Basically just wanting to compare with others if you have noticed any patterns between family members.  Thank you much!!

<{POST_SNAPBACK}>

Hi Ahalo

One thing I can tell you is that depression, anxiety, substance abuse, and such has a strong tendency to run through families. Almost every member of my family at one time or another has had some sort of MI problem or substance abuse issues.

My pdoc told me when he was taking my history said to me "you never had a chance" with the history which runs through three generations. He also told me that it is very probable the same meds would work because we have the same biology.

Although that's not always 100% the case, he certainly would start with a med that worked for another family members problems. There are both hereditary and environmental forces at work here .

The short answer is yes, absolutely.

But the patterns won't always be the same, because even though we have the same biology, we experience life differently so there will be deviations.

That's my unprofessional opinion.

John

[katgrrl]

Basically just wanting to compare with others if you have noticed any patterns between family members.

[gretl]

The short answer is yes, absolutely.

But the patterns won't always be the same, because even though we have the same biology, we experience life differently so there will be deviations.

Yep, I think doctors factor it into treatment plans (maybe as a good starting place), but don't count on it too heavily.  There are familial genetics involved in the how a body metabolizes different substances, but there are also environmental effects starting from conception that tweak our genes and our biochemistry.

A couple of abstracts, FWIW:

Familial concordance of fluvoxamine response as a tool for differentiating mood disorder pedigrees.

Concordance to antidepressant response in members of the same family is a common observation in clinical practice. However, few published data support this view; moreover families with affected members responder to the same antidepressant have been poorly studied. We have analyzed 45 pairs consisting of one mood disorder fluvoxamine double-responder proband and one first-degree relative with known outcome to fluvoxamine treatment. Among 45 pairs 30 (67%) were concordant for good response to fluvoxamine. In family pedigrees of concordant pairs we found a significantly higher distribution of bipolar forms in secondary cases than in families of non concordant pairs (14.9% vs 3.9% P = 0.039) suggesting that concordance to antidepressant therapy could select families with higher genetic loading.

J Psychiatr Res. 1998 Sep-Oct;32(5):255-9.

Pharmacogenetic response to antidepressants in a multicase family with affective disorder.

Eight members from two generations of a family met the DSM-III-R criteria for major depression. Four individuals had severe prolonged depressive disorders that did not respond to standard therapeutic doses of tricyclic and new generation antidepressants, but subsequently responded to the monoamine oxidase inhibitor, tranylcypromine. The literature on pharmacogenetics of the antidepressants is sparse. The pattern of selective response to tranylcypromine in this family supports the view that there is a familial tendency to respond to specific antidepressants or antidepressant groups. A history of response to a specific antidepressant in a relative may be helpful when selecting an antidepressant. Families demonstrating preferential response to specific psychotropics may be suitable pedigrees in which to perform linkage analysis using candidate genes related to the site of action of that psychotropic drug.

Biol Psychiatry. 1994 Oct 1;36(7):467-71.

It looks like most of the clinical research now is focusing on individual genetic testing to predict antidepressant response, regardless of familial response.  Once they get that down, it won't matter that the same med worked well for sis, mom, etc.!

Edited to add  Sorry - to answer your original question (before I went off on a tangent!), so far my daughter and I respond similarly to most meds, but not all.  But our diagnoses aren't identical, either.

[ahalo]

I noticed that you have posted that Cymbalta worked for your mom when other didn't. That being the case, let me throw this out - it could be that your family suffers from problems with norepinephrine.

<{POST_SNAPBACK}>

What types of things would also suggest that the problem could be norepinephrine?  As in responses to certain meds, etc?  I am just not together enough to really understand the differences and stuff like that...  Both my mom and brother respond very well to Clonazepam; my brother hasn't had luck with SSRIs much, he is on Paxil and it doesn't help much--though Prozac did very much help his OCD years ago, it didn't do anything for the anxiety and depression.  I've responded to a very very low dose of Abilify, so I guess I should look into that med more to see how it works.