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Otter

Pharmacogenetics influence on tapering

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Otter

Hi all,

Is anyone familiar with pharmacogenetics and the influence of gene variation with the 5-HTT pathways on drug metabolism/half life/plasma concentration as it pertains to SSRI withdrawal? I have found a number of studies examining the effects of rapid metabolizing on drug concentration, but none examining the linkage to withdrawal syndrome. 

I have my raw genetic data file from a 23andme test I got as a gift some years ago and I like to go through and read SNP variants. I found out that I have a genetic predisposition for polycystic kidney disease this way, strangely enough. It's just that with immigrant parents who come from a third world country, if you maternal grandmother is the first person to survive past the age of 60, you just don't build up a family history of the diseases associated with aging (haha)....

Anyways, I happen to know that I have a few gene variants associated with an extensive/rapid metabolizer CYP2C19 enzyme (specifically CYP2C19*17 rs12248560). This enzyme is responsible for the breakdown of a number of different drugs - plavix, omeperazole, but also with a number of antidepressants (amitriptyline, citalopram, sertraline, etc). I understand that those who are ultrarapid metabolizers like myself may need larger doseges to achieve a treatment response.

This also leads me to wonder if the fast metabolizer would hit that wall that "uh oh" point that I have read about in other posts more rapidly, or at an earlier taper point, than those who are normal or inefficient CYP2C19 enzymatic activity.

Thanks in advance for any info! Cheers.


1999 - Wellbutrin 150 mg ~ 4 months - cold turkey withdrawal (adverse reaction)
2001-2002 - Lexapro 10mg, lorazepam 1mg - cold turkey withdrawal induced a 2 week subacute seizure cluster
2002-2006 - Clonazepam 1mg, Prozac 40mg
2007 - Added Abilify (adverse reaction - hand tremors) 
2007-2008 slow wean off everything
2014 - Zoloft/Sertraline 50mg, increased to 200mg over the course of a year. 
2015 - Added Atarax 50mg
2016 - Added Gabapentin/Neurontin 1200 mg

June 2016: Rapid Gabapentin wean, rapid sertraline taper 200 - 100 mg

Current meds: 100mg/day of sertraline, 50mg atarax. 0.25mg klonazepam as needed (usually every other day or two)

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Altostrata

There is no identifiable effect of pharmacogenetics on tapering. Each person has to find his or her individual most comfortable tapering schedule.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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Otter

There is no identifiable effect of pharmacogenetics on tapering. Each person has to find his or her individual most comfortable tapering schedule.

No existing/known effect but it has not been ruled out? 

 

I have be be specific in semantics because of my training, in my line of work if we say there is no identifiable effect, chances are no young researcher will attempt to discover if there actually is a relationship. And I certainly hope that if one exists, it is soon discovered, because more evidence from pharmacogenetics could greatly reduce the types of issues we see with SSRI therapy.


1999 - Wellbutrin 150 mg ~ 4 months - cold turkey withdrawal (adverse reaction)
2001-2002 - Lexapro 10mg, lorazepam 1mg - cold turkey withdrawal induced a 2 week subacute seizure cluster
2002-2006 - Clonazepam 1mg, Prozac 40mg
2007 - Added Abilify (adverse reaction - hand tremors) 
2007-2008 slow wean off everything
2014 - Zoloft/Sertraline 50mg, increased to 200mg over the course of a year. 
2015 - Added Atarax 50mg
2016 - Added Gabapentin/Neurontin 1200 mg

June 2016: Rapid Gabapentin wean, rapid sertraline taper 200 - 100 mg

Current meds: 100mg/day of sertraline, 50mg atarax. 0.25mg klonazepam as needed (usually every other day or two)

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