When I wrote my last blog, Tracey’s Anti-Anxiety Recipe, I hope I didn’t give the impression that I eschew pharmaceuticals. There is such a bias against medication that I don’t want contribute to that. Pharmaceuticals have been a godsend for me. I simply could not have wrestled my depression into submission without them. But it hasn’t been a simple “take a pill” — far from it. It’s been a bit of a journey to find the right drugs for my depression.
Upon release from the hospital, my drug regimen was Paxil 60mg, Remeron 7.5mg, Lo’Ogestrel (birth control), and Vistaril 50mg. Over the next few years, my psychiatrist adjusted my regimen to add Lithium 450mg and dropped the Vistaril. While I was light years better than I had been in the hospital, I was still plagued with periodic hopelessness, depression, and suicidal thoughts. They weren’t constantly present as they had been, but still too often to call my life fulfilling.
In 2017, I started having overwhelming fatigue. I was falling asleep during the day – at the wheel, during meetings – and sleeping my weekends away. It was terrible. I felt my life was becoming meaningless as I had no energy to do anything. My doctor tested my thyroid and decided it wasn’t functionally optimally, so she added Synthroid to my drug regimen. But the fatigue remained. Then I had a sleep study that showed no sleep apnea or narcolepsy. I was diagnosed with “idiopathic sleep disorder” which basically meant no one knew.
I had the sneaking suspicion it was the Paxil. I researched all the side effects of my meds, and only two had sleepiness: Paxil and Remeron. I have been taking low-dose Remeron to help me sleep for two decades, so that wasn’t the culprit. I asked my psychiatrist to switch the Paxil. She was very concerned about making me worse, so she ordered a DNA test to help us choose the right drug.
The DNA test was so fascinating. Here’s what it revealed:
- I am a poor metabolizer of Paxil, Prozac, Effexor, Trintellix, and all of the tricyclic antidepressants. This meant I had a lot of Paxil built up in my system and I wasn’t processing it properly. It also meant I could expect to have a lot of side effects from the others.
- I am an intermediate metabolizer of Fetzima, which means I metabolize it okay, but not optimally. Fetzima is SNRI, so it’s different from an SSRI in that it also increases norepinephrine, which can be dicey for someone like me who has agitated depression. (When I get depressed, I get antsy, can’t sleep, restless rather than lethargic and not able to get out of the bed.) So Fetzima was our last option.
- There is no antidepressant that I metabolize normally, so we were left with the ones I metabolize fast: Zoloft, Celexa, and Lexapro. We chose Zoloft. To deal with the ultra-rapid metabolizing, I take half of the dose in the AM and the other half at lunch. I sometimes take a 25mg extra in the late afternoon if I feel my mood drop. Within 15 minutes my mood lifts. It’s crazy amazing.
- Another interesting finding is that I have the MTHFR mutation. This means no matter how much Folate I get, my body can’t convert it and use it. The converted form l-methylfolate shuttles tryptophan into the brain, which is how the brain makes serotonin. There’s no way to measure serotonin in the brain, but it’s likely I have a shortage. Antidepressants do not make serotonin, but block the uptake of the serotonin so the brain can use it longer. But if there’s a shortage of serotonin, antidepressants don’t have the ingredients to do their job. So I now take 15mg of l-methylfolate daily.
This new drug regimen is the ticket. I started this back in November 2017, but I wanted to wait several months before declaring to the world that this is working. I’m happy to report it is. I’ve not had suicide thoughts at all so far this year.
If your meds aren’t the best, I highly recommend the DNA test. It wasn’t covered by insurance which sucks. It cost $250, but saved me the pain and anguish of the trial and error approach that’s standard in psychiatry.
The DNA also tested anti-psychotics, analgesics, opiods, muscle relaxants, benzodiazepines, nsaids, and platelet inhibitors. I found out that I am a poor metabolizer of codeine, oxycontin, tramadol, and vicodin. This means I can overdose on these meds at normal doses. Pretty good information to know. The codeine was interesting because I’ve also hated the way it makes me feel, and list it as an allergy even though it’s not really an allergic reaction. Now I know!
The company we used is Millenium Health – the test is the PGT. Your doctor has to order it.