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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Dinah on October 26, 2012, at 17:21:54
Has anyone heard of any DNA testing to try to match people and the medications most likely to help them?
The medications involving norepinephrin were awful for me. But I suppose any really good pdoc could have foreseen that. But I think my time on SSRI's was also bad for my brain. That might not have been so obvious.
I know they're doing DNA research on drug sensitivities and likelihood of disease in general. Does anyone know of any mental health specific research going on?
Posted by Phil on October 26, 2012, at 17:28:41
In reply to DNA testing, posted by Dinah on October 26, 2012, at 17:21:54
Non-answer but no, I don't and I'm not holding my breath either.
Posted by Dinah on October 26, 2012, at 17:42:23
In reply to Re: DNA testing » Dinah, posted by Phil on October 26, 2012, at 17:28:41
There's already some testing out there. It's not perfect, but it's the right direction. 23andme, I know, is doing preliminary research on SSRI responders. But I was wondering if there was anything scholarly going on. And anything more widespread than just SSRI's. I already know I respond poorly to SSRI's, whatever my DNA says. :)
Posted by Emily Elizabeth on October 26, 2012, at 17:45:58
In reply to Re: DNA testing » Phil, posted by Dinah on October 26, 2012, at 17:42:23
My former pdoc says she has started using AssureRX for this purpose and has found it very helpful. She didn't start until I moved out of state, so I don't have first-hand experience.
Best,
EE
Posted by Dinah on October 26, 2012, at 17:47:52
In reply to DNA testing, posted by Dinah on October 26, 2012, at 17:21:54
Posted by Dinah on October 26, 2012, at 17:52:42
In reply to Re: DNA testing, posted by Emily Elizabeth on October 26, 2012, at 17:45:58
I can see from AssureRx's front page that there is research going on.
In what I've read so far, it seems to be rather tentative and express things in terms of greater or lesser likelihood. But the field is growing in leaps and bounds. Surely one day they'll be able to bypass the guesswork and potentially harmful med trials.
I'll read the articles there and see what I think.
Posted by Twinleaf on October 26, 2012, at 17:55:26
In reply to DNA testing, posted by Dinah on October 26, 2012, at 17:21:54
I had a form of it done several months ago. It was useful. I always responded so badly to SSRIs, and found that I have a variation that causes me to metabolize them very poorly. On the positive side, l learned that I metabolize dopamine too quickly in my frontal lobes. TMS and drugs that cause dopamine to hang around longer, such as AAPs and Lamictal, are indicated for this. Although only a few genes are tested at present, it's a good beginning. And my insurance paid for it!
Posted by Dinah on October 26, 2012, at 18:10:14
In reply to Re: DNA testing » Dinah, posted by Twinleaf on October 26, 2012, at 17:55:26
Cool! I'm sure my insurance would never pay for anything like that. :( It won't even pay for my glucose monitor.
Can you tell me more about dopamine and the frontal lobes?
I've not really noticed Lamictal much but it certainly hasn't hurt and does seem to keep me on more even keel. It would be interesting to know if had different properties than Depakote. I've had a curious affinity for AP's since I was little. They are wonderful for the anxiety that seems to run its way through everything in me. I told my therapist that both he and AP's are good for my ego strength. Ego strength in a bottle. I feel more grounded and less scattered with just a smidge of Risperdal as needed. Benzos are ok for a quick calming of the nerves when needed. But they're no substitute for the bone deep calm that comes from an AP.
Posted by Dinah on October 26, 2012, at 18:16:49
In reply to DNA testing, posted by Dinah on October 26, 2012, at 17:21:54
It occurred to me to wonder if genetic testing could determine which disorder involving psychosis runs in my family. It doesn't look like it will anytime soon.
Posted by Phil on October 26, 2012, at 18:30:19
In reply to Hmmmmm...., posted by Dinah on October 26, 2012, at 18:16:49
http://www.behavioral.net/article/saliva-based-gene-test-said-predict-psych-med-response
Posted by Phillipa on October 26, 2012, at 18:41:52
In reply to Re: Hmmmmm.... » Dinah, posted by Phil on October 26, 2012, at 18:30:19
I didn't know any was going on other than geonome. Phillipa
Posted by Twinleaf on October 26, 2012, at 18:42:18
In reply to Re: DNA testing » Twinleaf, posted by Dinah on October 26, 2012, at 18:10:14
I don't know too much more - just that I have a gene variation associated with dopamine being metabolized too quickly in my frontal lobes. I have the same response as you to the AAPs. My pdoc seems to feel that regular very low dose AAP will have a protective effect against depression, but, so far, I am using TMS as needed, as it has many of the same effects, and is safer though TERRIBLY expensive! Luckily, it's been a while since I have needed it.
You might like having the testing, as it does put medication decisions on more solid ground ( my pdoc is crazy about it).
Posted by Twinleaf on October 27, 2012, at 8:02:55
In reply to Re: DNA testing » Twinleaf, posted by Dinah on October 26, 2012, at 18:10:14
I know you have diabetes, but if drugs like Risperdal ( in extremely low dose) help so much with anxiety, and likely depression also, would it be too risky for you to take it regularly? If you have reasonably good control over your blood sugar levels, would, say 0.5 mg. daily be safe to take? I am weighing this option for myself because of the genetic testing and my pdoc's strong recommendation. I was thinking that I would need to change my diet more towards a diabetic (or a "paleo") type diet if I decided to do that.
If you were considering that, the genetic testing to see if you have the variant causing low frontal lobe dopamine might be helpful.
Posted by Dinah on October 27, 2012, at 8:37:54
In reply to Re: DNA testing » Dinah, posted by Twinleaf on October 27, 2012, at 8:02:55
I have the sense that Risperdal is not only safer used as needed, but also more effective. I do stay on a low dose Risperdal during periods of stress. So that for a week or so, I add it to my morning medications.
I stop feeling it, and the dry mouth annoys me.
My energy level and anxiety level fluctuate so wildly that I find I'm happiest with as needed medications. I've been relatively stable on this for a while now, and sort of wonder why my pdoc wishes to see me quarterly. Other than that he's very cautious.
He does surprise me sometimes, though. Maybe I'll ask him if he uses it.
Posted by Dinah on October 27, 2012, at 8:58:35
In reply to Re: DNA testing » Twinleaf, posted by Dinah on October 27, 2012, at 8:37:54
I suppose the downside is that there is sometimes a lag between my needing the medication and my being aware that I need the medication.
I try to be aware of the physical symptoms of high anxiety.
Sigh. I really wish I hadn't so disliked the only biofeedback provider in the city. That's the other thing that really excited me about the possibilities.
Posted by Twinleaf on October 27, 2012, at 9:17:33
In reply to Re: DNA testing » Twinleaf, posted by Dinah on October 27, 2012, at 8:37:54
Sounds like you've already got your medications the way you need them to be. For now, I'm just weighing my options, also - not committing to an AP despite some pdoc pressure.
Posted by SLS on October 27, 2012, at 13:41:48
In reply to Re: DNA testing » Dinah, posted by Twinleaf on October 26, 2012, at 18:42:18
> I don't know too much more - just that I have a gene variation associated with dopamine being metabolized too quickly in my frontal lobes. I have the same response as you to the AAPs. My pdoc seems to feel that regular very low dose AAP will have a protective effect against depression, but, so far, I am using TMS as needed, as it has many of the same effects, and is safer though TERRIBLY expensive! Luckily, it's been a while since I have needed it.
>
> You might like having the testing, as it does put medication decisions on more solid ground ( my pdoc is crazy about it).Where did you get genetic testing? How much did it cost?
Are you still seeing the same doctor for rTMS? Atlanta?
I hope the time never comes for you, but if it be necessary, you could look into the use of Abilify as an antidepressant AAP. It seems to act to stabilize dopamine function rather than to push it to its extremes.
- Scott
Posted by Twinleaf on October 27, 2012, at 16:33:20
In reply to Re: DNA testing, posted by SLS on October 27, 2012, at 13:41:48
My pdoc took a saliva sample and sent it in to Access. It cost $275 (which insurance paid) and tested for just eight gene variants.
Glad to know that about the Abilfy! The Risperdal is helpful for both anxiety and in preventing mood dips, but even 1 mg. per day gives me a slight unsteadiness of gait - you can't see it, but I know it's there. I will discuss it at my next visit n November. Thanks Scott.
I don't need TMS nearly as much as I used to, but when I do, I can get it from my pdoc locally.
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