Posted by Amelia_in_StPaul on June 23, 2009, at 12:13:45
In reply to Re: Sigh. Abilify is now prescribed. What about Luvox?, posted by Brainbeard on June 23, 2009, at 6:43:43
> No no, not all of them. Clomipramine only uses 2D6 a little bit and is mostly metabolized by 1A2 and 3A4. Luvox (fluvoxamine) also doesn't even touch 2D6 but gets broken down by 1A2 and 3A4.
Hmmm...my Mayo report says that fluvoxamine is metabolized by 2D6. I have just done some googling--trusted sources say that it is metabolized by 2D6 but also by 1A2 and 3A4--perhaps the main thing is the multiple pathways, and the fact that it doesn't inhibit 2D6, unlike the other SSRIs. Inhibition is the key for me. It renders me a poor metabolizer.
> Zoloft (sertraline) is metabolized mostly by 3A4; 2D6 plays only a minor role, perhaps it becomes more prominent on higher dosages, when sertraline also begins to inhibit 2D6.Yes, I was just going to say, Zoloft does inhibit 2D6. So, I'm not interested in that. "There is variability among the drugs effective in the treatment of major depressive disorder in the extent of clinically important 2D6 inhibition, and in fact sertraline at lower doses has a less prominent inhibitory effect on 2D6 than some others in the class. Nevertheless, even sertraline has the potential for clinically important 2D6 inhibition." http://www.druglib.com/activeingredient/sertraline/
>
For imipramine too, 1A2 and 3A4 are more important than 2D6. Citalopram (Celexa) is not metabolized by 2D6 but by 2C19. Escitalopram (Lexapro) is mostly metabolized by 2C19 too, but also by 3A4 and 2D6.Celexa would be great. My genetic profile = nonresponse. I mean, I tried it and did not respond. Then I got this genetic testing; and my genetic profile shows that HTR2 polymorphisms would in fact lead a nonresponse to occur. So that's out.
Lexapro--I couldn't make it past the initial side effects. Very dirty drug, to me.
Imimpramine--yeah, I could try that.
> So, from a 2D6 point of view, Luvox or Celexa would be completely fine.
Yes. But, sigh, from my HTR2 profile, Celexa is out. I'll probably end up trying Luvox though.
> > Yes, I have OCD too. The pure O version (I know that's a misnomer; I do have mental compulsions, after all).
>
> Pure O here too. I stopped performing classical (fysical) compulsions ages ago. Well, there are still some compulsive acts, but I don't wash my hands hundred times a day anymore, to mention something.Wow, good for you!!!
> I'm buying most of my meds myself, over the internet. My p-doc was so friendly to prescribe the sertraline (Zoloft) for me. She didn't want to prescribe the ondansetron. I can only hope that I'll find a p-doc who writes prescriptions like there's no tomorrow.
That would be great. Let me know which rock that person is hiding under, so I can coax them out to help me too. :-)
> Acupuncture - not for me. I stay clear from most alternative kinds of health care. Too much occultism. Wrong roots (just my opinion). In my country (Holland), most of that stuff is being covered though.
Jeepers, you're kidding? It's covered? I wish. I have seen small studies that show an improvement. I personally think there is a scientific basis, not occultism. I think that the rush of endorphins that comes as a result of the needle-pricking is the key. But I am skeptical about lasting effects.
> > Well, we'll see anyway. I just know I am not going back the SRI route. And I am NOT going on an antipsychotic. I am not wrecking my body any more.
>
> Hate to say it, but psychological problems can wreck your body (and your life, your relationship, etc.) too. Sometimes one has to choose the lesser evilThank you. You're right. I was thinking about this last night. I get very angry at what I've gone through with Prozac, and with how little time pdocs have--and how little they actually listen to the patient. But I am quite sure that I won't get better without a medication. It's hard though when you haven't gotten better much at all over two years, and you have been on meds. I'm sure you understand my frustratin.
>
> > Good luck to you. Sounds like you have a good idea of what's going on with you and what will work. You must have a heck of a good pdoc.
>
> I sure have. ;) No, thanks. And good luck to you.
>Thanks, man. Thanks for talking about 2D6. It's helped me parse things out a bit. I'm apt to say "no more"! But maybe there's something out there for me. Maybe Luvox. Here's to hope!
poster:Amelia_in_StPaul
thread:902046
URL: http://www.dr-bob.org/babble/20090620/msgs/902746.html