Posted by Zatar on October 27, 2011, at 22:42:40
In reply to Re: Can't tolerate meds,TIRED all the time, + Deplin, posted by Iden on October 23, 2011, at 12:15:41
> Based on my personal experience with a number
> of psychiatric drugs and not tolerating them well,
> drug metabolism did come to mind.
>
> Your comment about Remeron is curious though.
>
> You mention Prozac. The usual starting dose of
> 20 mg / day caused me considerable side effects
> so I quit. Experiencing considerable depression,
> I would begin again, same result. It eventually
> occurred to me to try a partial dose. Prozac can be
> dissolved in a given amount of water and portioned
> out using a graduated cylinder. It keeps fine in the
> refrigerator. Over time, I learned that if I was
> going to re-start Prozac, I needed to start at 2 mg/ day
> and over weeks work up to my max of 5 to 6 mg /day.
> This is just one drug as an example.
>
> I eventually had an idea and made a list of all the
> psychiatric drugs I had a problem with and then
> sought to see how they were metabolized and see
> what they might have in common.
>
> It turns out that liver enzymes P450 2D6 and/or
> P450 2C19 can be the culprits if enzyme activity
> is low or very low. Such people are called "poor
> metabolizers."
>
> To explore this, if you haven't, try Googling
>
> P450 poor metabolizer
> P450 2D6 poor metabolizer
> P450 2C19 poor metabolizer
>
> Regarding Deplin, it made me feel sick and I quit.
>
> I tried again, same.
>
> I tried 1/4 of a tablet / day. Made me feel bad.
>
> I tried 1/4 of a tablet every other day and it
> made me feel bad. The pdoc I see strongly
> encouraged me to keep trying. It is hard to
> keep taking something that makes me feel worse.
>
> Iden
>I started Prozac at tiny doses as I do with every drug I attempt. I was even opening up Cymbalta capsules and counting out pellets.
Of course I thought about being a slow metabolizer, but years ago, when I was first diagnosed, I was able to tolerate regular doses of Remeron and amitriptyline without the side effects. Rather than drug metabolism changing, it seems more likely that the receptors have changed or some other pathway has ramped up or down. Or there is some speculation that some serotonin receptors are not functioning properly and there might be an increased amount of serotonin available at other receptor sites.
Codeine and propranolol are also metabolized by 2D6 and I can tolerate usual doses of those.
I'm thinking that maybe I have more mitochondrial issues going on. May need to try the carnitine or BCAA route. And maybe taking care of energy issues will improve secondary depression.
Wish I knew what subtype of FMS and CFS I was...
-Zatar
poster:Zatar
thread:1000203
URL: http://www.dr-bob.org/babble/20111027/msgs/1001026.html