Genetic testing for meds

[ovOidampUle]

I'm sharing the results of my genetic testing in case people are curious about what it's like.

 

My psychiatrist explained this test looks at genes to determine how our body metabolize certain chemicals. In other words, it answers the non-obvious question, "What happens to the drug after it enters my body?" Sometimes the drug triggers the right reaction and the drug works as advertised. Other times your body might not know what to do with the drug and dump it straight into your kidney... and a lot of possibilities in between. Once you have some answers, the psychiatrist can better target meds for your condition. If you've ever taken one class of drugs that has done nothing for your condition, then taken a different class that worked miraculously, then a test may have saved you the trouble. 

 

The key results from my test were:

 

1) My body metabolizes stimulants very quickly. That means adderal and ritalin won't work for very long, even if they are extended release. If I am going to take them, I need to take them more often & higher doses.

 

2) There's a process that turns folic acid into neurotransmitters (norepinephrine, serotonin, etc.). In my body, that process is messed up and so it's likely I'm not generating enough of my own neurotransmitters. There's a medication that skips the step I'm having trouble with and so the process can continue. 

 

3) I don't know if genetic testing can say anything about the effectiveness of Brintellix.

 

Has anyone else had the testing done? What were the results? Were they useful? 

Edited June 26, 2014 by ovOidampUle

[malachite]

I actually recently had this test done. It was inconclusive....yay! I guess my body is fine on the meds I'm on. That was all my pdoc really said.

[HeidiHeidiHo]

I was just searching about this very topic yesterday.  I'm so frustrated by the constant "try this" with less than stellar results.  The idea of medicine personalized to my own body makeup is very intriguing.  Was it your idea to do the genetic testing or your doctor's?

[ovOidampUle]

Malachite- Hooray!

 

I've been doing some research on the folic acid process, and the research is unclear if it causes depression or not. If it is a problem, it's not clear if regular B vitamins (50 cents a month) would help or if I need to get the fancy "medical food" (50 dollars a month). Given that the research is murky and given the fact that I got a sales call from the company offering me a low, low rate, I'm going to steer clear of the fancy pills. 

[ovOidampUle]

I was just searching about this very topic yesterday.  I'm so frustrated by the constant "try this" with less than stellar results.  The idea of medicine personalized to my own body makeup is very intriguing.  Was it your idea to do the genetic testing or your doctor's?

 

It was the doctors idea. I don't know if you can hook your doctor into taking an interest. All my doctor had was a swab kit and an return envelope from the testing company. I didn't see the report, but I think it lays out the recommendations so he doesn't need a separate degree in genetics.

[quiet storm]

I did the genetic testing from 23andme while back for $99 and I think it answered a few things for me.  Genetic testing IMO is huge when it comes to crazymeds and I think should be something is done more often. Not everyone has the same enzymatic action when it comes to metabolizing drugs and it doesnt take a rocket scientist to see that two people taking the same medication at the same dosage might have two very different responses due to having a different enzymatic action level. For example, the enzyme CYP2D6 is responsible for metabolizing and eliminatiing about 25% of all cliniclally used drugs. But did you know that about 6-10% of causasians are consdered poor metabilizers(african americans are higher) and have little to no enzymatic action? On the other end you have ultra rapid metabolizers. And in between you have extensive(considered normal) and intermediate(between extensive and poor). CYPD26 is responsible for metabolizing a shitload of crazymeds. CYP3A4 is another one. My results indicated that I probably have some reduced CYP2D6 action, which makes sense to me as I've always done better on lower dosages of the meds I've been on that CYP2D6 extensively metabolizes. CYP3A4 came back as normal.

 

CYP1A2 is the main one I came back with that had severely reduced acitvity. CYP1A2 is the enzyme that metabolizes caffeine. When I saw that it made sense to me why I felt so much better after I quit caffeine a while back due to stomach issues. I sleep better, am less anxious, blood pressure dropped a few points, and the chronic headaches I'd been having for years are gone by about 90%. I was barely metabolizing the shit.

 

I think it goes along way to explaining why meds treat us all different and I think its a very underutilized tool.

 

And then there's the whole methylation side that deals with how our body uses and metabolizes B vitamins like folic acid(some people cant at all, some at a very reduced rate........enter methylfolate...AKA metafolin......in prescription form known as Deplin), B12 and B6 and many other things like how efficiently your body breaks down serotonin and dopamine. Not everyones the same. Very, very interesting and insightful.

Edited June 26, 2014 by quiet storm

[Spadez87]

I'm sharing the results of my genetic testing in case people are curious about what it's like.

 

My psychiatrist explained this test looks at genes to determine how our body metabolize certain chemicals. In other words, it answers the non-obvious question, "What happens to the drug after it enters my body?" Sometimes the drug triggers the right reaction and the drug works as advertised. Other times your body might not know what to do with the drug and dump it straight into your kidney... and a lot of possibilities in between. Once you have some answers, the psychiatrist can better target meds for your condition. If you've ever taken one class of drugs that has done nothing for your condition, then taken a different class that worked miraculously, then a test may have saved you the trouble. 

 

The key results from my test were:

 

1) My body metabolizes stimulants very quickly. That means adderal and ritalin won't work for very long, even if they are extended release. If I am going to take them, I need to take them more often & higher doses.

 

2) There's a process that turns folic acid into neurotransmitters (norepinephrine, serotonin, etc.). In my body, that process is messed up and so it's likely I'm not generating enough of my own neurotransmitters. There's a medication that skips the step I'm having trouble with and so the process can continue. 

 

3) I don't know if genetic testing can say anything about the effectiveness of Brintellix.

 

Has anyone else had the testing done? What were the results? Were they useful? 

Hey, im a canadian but head this DNA test done through CAMH in toronto. Im an Ultra rapid metabolizer of CYP2D6. Most drugs on the market today from pysche drugs to most opiates, stimulants etc go through this liver enzyme.  I can't take most drugs how they are supposed to used. for example codeine turns to morpine via this enzyme and a normal dose of codiene could kill me due to how rapidly the codiene turns to the MUCH stronger morphine thus causing an OD.

 

I too rip thru amphetamine. More then likely why im still alive after ridiculous doses of speed and MDMA when i was younger,

 

The is 4 genetic phenotypes that anyone could be. A poor metabolizer, intermediate, Extensive (8 out of 10 ppl are this and its "normal' and most drugs will work as they are supposed to) and ultra rapid metabolizer (apparently only 1-2% of the world has this type of phenotype, lucky me)

 

Anyways this test will be standard sooner or later. it will save lives. I now know why the 20 different psyche drugs ive tried never worked. just caused side effects. Also is why i take a percocet of a T3 its like i did a 10  bag shot of heroin.

 

Im glad i did the test, it was free (even got 20 bucks for it lol, i love canada) and now i know whats been going on over the last decade.

Edited June 26, 2014 by Spadez87

[shesellsseashells]

ovOidampUle, if you don't mind my asking, was this test covered by your insurance co.?  Thanks.

[melissaw72]

Thanks for posting about this!  I brought it up to my pdoc awhile back, but he didn't know if it was actually being done yet.  Now I can tell him it is being done.

 

I'd also like to know if it is covered by insurance (and if so, which one/s).

[ovOidampUle]

Quiet storm - I've already learned not to mistake data for information. I was doing some research on the folic acid business you mentioned -- my doctor recommended Deplin -- and the link between folate levels and depression is mixed. And there's an open question of whether the genetic mutation means there is less actual amino acids in the brain or just in the bloodstream. Or something. I haven't found any evidence that makes me want to spend $50/month. Though inevitably it probably land at pharmacies as a nutritional supplement. 

 

That's interesting about caffeine. I never got hooked on it for some reason. Maybe I metabolize it really quickly? But it points to one weird thing about tests like this -- in a way, it tells us things we already would know if we were paying attention. 

 

I see what you did there with your icon. 

 

Spade - I think the mutations make us different than the majority of people that showed the drug worked. I wonder if people will start going back and exploring some drugs with small effect sizes to see. Maybe they'd be very useful to people with the right mutation, but not useful for anyone else. That's really the issue with these mutations -- the drugs aren't designed and tested for people with mutations. It's almost as bad as being a woman.

 

Anyway, it's good information to have; hopefully doctors will start requesting and using more of this information. After all, I'd say a good 60% of a psychiatrist time is spent prescribing medications that don't work. 

 

S⁴ & Melissa - Let me put it this way: the doctor said it was covered by my insurance and I haven't yet received a bill. I'm on Medicare/medicaid (in the imperialist corporate oligarchy of the United States). 

[Phoenix_Rising]

Thanks for posting about this ovOid.  I find this very interesting and I love the idea of something to help stop the "med go round".

[quiet storm]

Quiet storm - I've already learned not to mistake data for information. I was doing some research on the folic acid business you mentioned -- my doctor recommended Deplin -- and the link between folate levels and depression is mixed. And there's an open question of whether the genetic mutation means there is less actual amino acids in the brain or just in the bloodstream. Or something. I haven't found any evidence that makes me want to spend $50/month. Though inevitably it probably land at pharmacies as a nutritional supplement. 

 

That's interesting about caffeine. I never got hooked on it for some reason. Maybe I metabolize it really quickly? But it points to one weird thing about tests like this -- in a way, it tells us things we already would know if we were paying attention. 

 

I see what you did there with your icon. 

 

Spade - I think the mutations make us different than the majority of people that showed the drug worked. I wonder if people will start going back and exploring some drugs with small effect sizes to see. Maybe they'd be very useful to people with the right mutation, but not useful for anyone else. That's really the issue with these mutations -- the drugs aren't designed and tested for people with mutations. It's almost as bad as being a woman.

 

Anyway, it's good information to have; hopefully doctors will start requesting and using more of this information. After all, I'd say a good 60% of a psychiatrist time is spent prescribing medications that don't work. 

 

S⁴ & Melissa - Let me put it this way: the doctor said it was covered by my insurance and I haven't yet received a bill. I'm on Medicare/medicaid (in the imperialist corporate oligarchy of the United States). 

 

First off, please realize I'm not demonizing folic acid..........The important thing to realize is folic acid does not equal folate. Well, for a certain percentage of people anyway. Folic acid is a synthetic compound that must be converted in the liver(where the reduced enzyme action comes into play) to the usable form of folate that the body uses. Folic acid is not a natural compound. It didnt exist until about 60 or so years ago. And then the FDA mandated foods be fortified with it in 1998. Its everywhere. I cant remember the demographics, but the problem with folic acid is that around 10% of the population has a 70% reduced ability to process folic acid into the usable form of folate. Another 40% has a less reduced ability, but still substantially lower ability to convert folic acid into the usable form of folate. Formulations like deplin and the OTC forms of folate I mentioned above are converted in the small intestine and therefore any enzymatic deficiencies that would occur from folic acid metabolism are bypassed. I have read conflicting studies on whether supplementing with actual folate like prescription deplin and the OTC forms like metafolin or 5MTHF(They are all basically the same thing...deplin is  much higher dosages...OTC preparations are limited by law) actually help with mood disorders. Some find very positive results. Some find little benefit. And that goes along with real world experiences you find online on message boards like these. Some swear by deplin. some say it didnt do a thing. I personally tried 1mg of the OTC folate while back, It was this brand:

 

http://www.iherb.com/Solgar-Folate-1000-mcg-120-Tablets/51772#p=1&oos=1&disc=0&lc=en-US&w=metafolin&rc=40&sr=null&ic=3

 

I personally found no benefit. Maybe I don't need it, or maybe the dosage just wasnt high enough. But I've seen alot of posts on other message boards where they swear that even 1mg of the OTC folate like I took helped them. Where more genetic testing would help I think would to be to see if there truly is a correlation between having the reduced ability to convert folic acid and seeing if there is a response to something like deplin. There's alot of info out there, but not enough actual hard studies. In the end, I  just think genetic testing should be another tool in the arsenal. I think it should become standard, especially in the more treatment resistant cases.

 

 

I was never hooked on caffeine either. I wasnt what you would call a big caffeine junky. I would drink a few cups in the morning, usually done by 9 or 10am.  But there's no doubt I feel better since stopping it. Maybe the poor metabolism had something to do with it. The half life of caffeine is around 5 hours in normal metabalizers. Probably far longer for me.

Edited June 29, 2014 by quiet storm