MED fear

I'm guessing the test could point to an snri over an ssri, for example. I think that is more the goal. Maybe even two ssri's that are a lot different but two that are so similar just doesn't seem likely. Can you try to get the name of the company that did the test? If not no worries but I am curious.



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Yeah, it was AssureRx.

Yeah, I think i'll have the piece of mind I am looking for if I talk to her about it first then make a decision.

Yeah we are both curious to see the results.

I just switched from Effexor to Fetzima and I am noticing a huge difference with Fetzima even though they are both SSNRI's. It could be that I am naturally just snapping out of my depression as usually happens with me or it could be the med. Hard to know.

Maybe your particular enzymes in your particular liver would metabolize Cymbalta totally differently then Pristiq for example even though they are both SSNRI's.

It has always been my understanding that genetic alcoholics (me) lack an enzyme that is part of the process of metabolizing alcohol whereas "normies" don't.
NIAAA Publications

There are also wide variations in ethnic groups and the enzymes in the liver. Asians vs Whites for instance metabolize drugs very differently.

I am still not convinced about the Effexor/Pristiq and Celexa/Lexapro "cleaned up" thing. If the exact same chemical enters your brain then what is the difference. But maybe they are metabolized differently. They were definitely developed by the drug companies to renew the patent and market it as a new drug.

It does look at how you metabolize the drugs and folic acid. This article has an example report:

http://www.nature.com/tp/journal/v3/.../tp20132a.html

It's the second image. It buckets the meds and assigns a reason why it is not recommended. In the example provided Effexor is in the red zone and pristiq is green. But if you read the notes it says it is red because of increased side effects not decreased effectiveness. That is just a risk. If you research the side effects and decide the pristiq is worth the extra money because the side effects are too much of a problem then you go that route. But if they aren't and you really can't afford the other maybe you try it. One logical way to decide is if you took another drug with an intolerable side effect and pristiq has the same one. You'll notice lexapro and Zoloft are in the same bucket with the same comment. Thinking one molecule isn't enough to differentiate them.

If that is what the report looks like I think they should be sharing it with you and you should even be able to take a copy. You or your insurance paid a lot of money for it! Kind of bums me out she decided not to share it.

Oh and they are divided by class so I think snri's would be on a different chart.

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No the SSRI"s and SNRI's are on the same chart.

The only way this can be true is if Venlafaxine (Effexor) produces other active metabolites besides just desvenlafaxine (Pristiq). And these other active metabolites produce the extra side effects. Whereas desvenlafaxine (Pristiq) doesn't produce these other active metabolites and thus is a "cleaned up" version. Hard to find any information to see if this is true.

https://www.pharmgkb.org/pathway/PA166014758
This link show the metabolic pathways of Effexor.

Can't really Find Pristiq. It is so much newer and has not been studied near as much. I think there are difference though in the metabolic pathways.

I would say es,citalopram is a shed load different to its older brother citalopram, you sound like a NHS shrink who wont give escitalopram because it costs more.

No I am just trying to figure out if there is really a difference. I am not going to pay more if there is no difference. You will find many articles saying there is no difference between Effexor and Pristiq.

In the UK the pdoc may be trying to save the NHS money and that is why but in the States we often have to pay out of pocket for a brand name drug. The insurance company won't cover Pristiq but they will cover Effexor. So you end up paying 200 bucks a month for Pristiq out of your own pocket.

Most insurance companies don't cover Abilify and it costs 600 a month. How is a guy gonna afford that out of his own pocket.

So cost becomes a factor in your decisions.

In your experience Lexapro may be a shed load different than Celexa but all the shrink has to do is say that there are no studies that say they are any different and dismiss you. There seems to be alot more difference in the metabolites between Lexapro and Celexa then there is between Pristiq and Effexor. You can at least argue with the shrink and the NHS and make a case for Lexapro.

Here it much more about what you are going to have to pay out of pocket and maybe you have no choice but to go with the cheaper generic even though the new one would be better.

Lexapro: The Son of Celexa | Psych Central Professional

Here in the states there are many different insurance companies. (Private) And then there is Medicare and Medicaid. (Government) They all have their different formularys. (List of which drugs they will cover) When a new drug comes on the market they have a team of "experts" that determine whether or not they are going to add it to their formulary and cover it. So Lexapro hits the market and they study it and usually say well it is to new and not enough studies so we will wait two years and look at it again. And there is generic Celexa we can buy real cheap so.....

If you think that it is all based on science and cost doesn't enter into it you are fooling yourself. If it is not on the formulary you are **** out of luck pal. Pay out of pocket if you want it.

I believe that is what it looks like because she mentioned the buckets like it shows. She didn't refuse to share it with me, we actually only spoke over the phone because I have been extremely depressed with Lexapro and she took time to call me back between patients to get me on a different med based on my results. I have an official appointment on Monday and I plan to ask for a copy at that time.

In the meantime, I did take Pristiq today because Lexapro has not been working very well (still depressed) and I now have additional side effects. So we'll see how this does for me and I'll talk to her Monday.

She did say that Lexapro and Celexa fall under the red category for me. I believe Pristiq was Green and Wellbutrin was yellow.

For me I don't care if I have to pay more for Pristiq over Effexor. Ultimately I was more afraid that they were similar and I would have the same side effects/withdrawal symptoms as people on Effexor do.

My insurance covers most of the name brand drugs and actually will cover Pristiq for me with a $75 co-pay, which is an acceptable amount IMO for a medicine that helps me function. Although I know for some people this is not the case and they may have to pay more than that. Cost is certainly a factor in the US, I agree there. If they wanted me to pay the full amount out of pocket for Pristiq I would have said no and opted for Wellbutrin.

When it comes to Celexa/Lexapro I know they are absolutely different in how I respond to them. Celexa helped me 100% for 7 years with 3-4 acceptable side effects. Although after year 7 something changed and Celexa started to make me extremely tired (basically turned into a narcoleptic) at which point the side effects were no longer acceptable but it was great for my mood and still is. Although if I take Celexa then I have to add Ritalin in just to keep me awake and I do not want to take Ritalin because of the dependance issues and the overall health risks. However Lexapro doesn't seem to work very well for me. I have had a few anxiety attacks and several days of deep depression on it. Additionally, I had some nasty side effects one of which is the fact that it makes me anxious, makes me feel like I'm high on meth (without the euphoria), head shivers, and a few other GI issues that i'll leave out as I am sure you all will appreciate.

Escitalopram is available in England either privately or through NHS. NHS won't prescribe it under certain conditions. They have a list on their website. They do prescribe it however. You can find a doctor here to prescribe anything you want but that really isn't what most people want . A doctor that has your best interest in mind might not prescribe it here either, all things being equal.

http://www.nhs.uk/medicine-guides/pa...20mg%20tablets

I am not as excited about that test as I was. I'm glad to understand it better though. All that chart tells you is you will metabolize one med better than another. That doesn't mean the med is going to help only that you won't up chuck it (proverbially speaking). Not that it isn't useful for a lot of people. It is. I just tend to not have issues with side effects as much. And I want to come off the drugs eventually, not add more.

Genomind does tell you more about a class of drug that might help more but looking at receptors. They also test for metabolism. Ultimately I am not sure this is all that I was hoping for either. I'll have to do some more reading.

http://www.genomind.com/products/sci...ehind-the-test

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LMAO,

I went looking for an example report and I found this instead:



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I am the opposite, I tend to have more side effects so I am hopeful this test will help me. I do not mind trying multiple drugs if I do not have side effects but since I do I am very cautious about the drugs I take.

I did take Pristiq earlier as I mentioned in another post and I'm feeling extremely tired just like I do with Celexa. I do tend to see affects of drugs very quickly, which is good but I fear this drug might not work.

I would say not so fast. How you metabolize a drug my have a great deal to do with how effective it is. Maybe that is why there is such variability in effectiveness as well as side effects. Lexapro is very effective for depression for one person and not another and maybe that is due to how they metabolize it differently.

Unfortunately you are right though, they can not peer into the brain and see how many receptors you have and what the drugs are doing and measure peptide levels and so on. Much easier to figure out how and what enzymes in the liver are processing drugs.

I tend not to have many side effects so I am lucky. It is hard to think that taking Pristiq for one day you would notice side effects. Like SewerRats says in the opening post to this thread you really have to give a med a couple of months to give it a fair chance and to overcome the side effects and to see if it works. That is if you can tolerate them for awhile. You can't expect it to work right away.

If you go to Wellbutrin I would be very surprised if it made you tired. It tends to be very activating.

I have taken Effexor many times on and off for long periods in the past. And I took Pristiq for a year. The Pristiq was more effective for my depression. I had the same two side effects with both that I considered acceptable. I think Effexor has plain pooped out for me I have taken it so much. My pdoc kept wanting to put me back on Pristiq. I opted to try Fetzima the newest SSNRI. I wonder if Fetzima was in your genetic test. I have noticed a big difference with Fetzima in just a couple of weeks. I am also having some withdrawal from Effexor so it kind of mixed up.

I got lexapro generic from the GP . FREE they have more money than the mental hospital , has its a private bought practice still NHS but they care more for there patients welfare has we are registered to the practice and no them personally not like the hospital your just a number and they can only give meds from the NHS rock bottom list, so in fact the GP,S are better all round than the mental zoo PS we never had Lexapro until generic , to much money for NHS and still to this day not in hospitals. Benzos we only have lorazapam and valium

Thats crazy there are tons of generic benzo's.
I was only using Lexapro as an example I didn't know there was a generic for it.
I just started Fetzima. Brand new, no generic. I got two months of samples from my pdoc. After that I don't know how things are going to work out as far as that goes.

I am glad you get good service from your GP.

WITH BENZOS , the NHS don't see the point of having an arsenal of benzos to kill anxiety . loz and valium came out most user friendly and cheap . You cannot run a thing like the NHS with multi choises there isn't the money .

I know they say it takes awhile but I actually do see benefits and side effects pretty quickly. I am not sure why but that seams to be my experience.

With Lexapro I started feeling the meth high right away. It definitely kept me awake after just 1 pill. Although it helped depression in the beginning it didn't last for long at all. It was bad for my anxiety because of the high feeling. I can say additional side effects showed up after 3 weeks when I didn't experience them straight away.

I am sure my doc will agree with you, she'll likely ask me to give Pristiq a few weeks before switching.

I thought you were going to hold off until you saw her. But sounds like you made a decision to go with Pristiq but are still on the fence. I guess you have to commit to one or the other and give it a chance.

Meds are such a pain in the ***. I have not given up on them yet.

Yeah I went ahead with the Pristiq because I had it on hand and the Lexapro side effects have become very hard to tolerate.

I'm glad you've made this thread, sewerrats. You've made an excellent point about people freaking out every time they take meds...how can the meds work if someone is so resistant to them? With all the attention given to the negatives of psych meds I wonder why there isn't more focus on the strong possibility that meds actually are helpful for our bodies because the meds decrease stress, anxiety, depression, etc., all of which are hard on our bodies.