About side effects.. Trying to understand

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What makes someone have side effects from a med?

Is it how we metabolize medications? Or something else?

Good question. I have no idea. Some people are just more reactive physically to things and have a tendency to react more to meds than others. I tend to have very few med reactions. My sister, on the other hand, always had pretty severe reactions to all meds. Same genetics. Different reactions. She was more allergy-prone (very much so actually), so perhaps that had something to do with it. I have no idea. I have allergies, but nothing too terribly out of the ordinary. Her general health was less stable: blood pressure, type-2 diabetes, severe allergies, several bouts with cancer, etc. I'm pretty much in good health. Is that it? I have no idea. Metabolism? Could be. Who knows?

I suspect there are a variety of causes of med side effects and actually predicting them is at this point a guessing game. I think medical science is LONG way from accurately being able to predict med reactions before actual trial.

Actually siblings have very different genetics. One has blue eyes one has brown. Simple example. They do have a lot in common though. Four kids me and my sister have depression. Hers is nothing compared to mine and has done great on wellbutrin for years. Me I am very med resistant and has severe depression. Then me and my brother are both alcoholic/addicts. My Dad is an alcoholic. (All clean and sober though. Thank god.) My other brother nothing wrong at all. (As far as we know...lol). I got screwed by the gene pool but it is what it is.

I am lucky in one sense in that I don't get many side effects or I get over them very quickly. There are a couple I tolerate but would really prefer not to have them.

Metabolism has a great deal to do with it and we all metabolize things differently due to genetics. Different races even more difference in metabolism. It depends on what genes you have that produce what enzymes in your liver. Every drug has a number of different metabolites after it goes through the liver. It is actually these metabolites that have the effects and not the original chemical. Some times the original chemical makes it through too unchanged but also with other metabolites. Very rarely a drug will make it through the liver unchanged all by itself with no other metabolites.

Effexor has like 6 different metabolites one being the original venlafaxine. One is des venlafaxine (Pristiq). But the thing is everyone is going to metabolize it somewhat differently, thus the different side effects for different people. So metabolism has a great deal to do with it. There are some genes tests out now that test how you might metabolize like 12 different AD's. And they rank them green, yellow, and red. Two show up in green those two are supposed to be the best for you at least are far as side effects go. I don't know about effectiveness. One girl here had it done and the two in green didn't work out worth a crap for her...so who knows. There is a whole thread on genetic testing in this section. It is very new.

So you are right they really have no idea what side effects one person might have compared to another and there are huge differences. You got to take it and find out. It is mostly based on metabolism and metabolism and the liver are well understood. You can take a drug and they can test your blood and see what metabolites turn up. The problem is drug company clinical trials are very limited and certain side effects show up and they test for metabolites on a limited number of people and make their side effect labels based on that. They don't really know though until a drug has been on the market a long time and then the FDA makes them change the label based on clinical reporting.

Then there is all the receptors you have. Like Effexor acts on serotonin, nor epinephrine, and a little bit on dopamine. They have a pretty good understanding of what it does in the brain at least in what is called the synaptic cleft. The little space between a neuron and a dendrite. SSRI (selective serotonin re uptake inhibitor) SSNRI (selective serotonin and nor epinephrine re uptake inhibitor.) Basically this means there is more serotonin and nor epinephrine available for use in the little space. The drug block receptors that would take it back up in the neuron cell. This is the whole chemical imbalance theory. There is a lot of debate now whether the theory is even valid or if anti depressants work any better than placebo. Yet tons of people do great on them and they are effective and tons of people do horrible and have lots of side effects. Or they are not effective at all. I am somewhere in the middle, hardly ever any side effects and never that effective. But my current new meds are working great, best ones I have ever been on. How do they explain that. They can't. They don't know why it works for one and not another. Its a crap shoot. You just have to keep trying. My view is that the chemical imbalance thing is a small part of the picture but it is very complex and they don't have much of a clue. Some people say the chemical imbalance theory has been proven false and was made up by the drug companies. It is true that you can't trust Big Pharma but I think their research is valid but a small piece of the puzzle.

There is new research into a big link between the pre frontal cortex (thinking rational part) and the limbic system (more primitive emotional part). Hippocampus, Amygdala, and hormone glands. Promising research but I don't know how you treat it. What is hard about it is that can't just cut into your skull and see what is going on. Hearts are totally different. They send cameras up your veins and do ultrasound and this and that and then they cut you open and fix it. They can't do that with the brain not even a camera going in. They have all these brain scans which are an awesome break through but as far as mental illness they are rather crude. Look up brain scans on a depressed brain compared to a non depressed brain and there is a huge difference. One guy posted a pic of a brain on adderall and a normal brain, huge difference. But it doesn't tell them what is really going on. Definitely a huge step forward. And they are great for brain damage and tumors.

Back to side effects. The other thing is you have serotonin and nor epinephrine receptors all over your body. There are more serotonin receptors in your intestines then in your brain. And serotonin regulates blood pressure, and body heat, sexual stuff, and a bunch of other stuff. So if those different metabolites bind to different receptor all over your body and not just your brain you get side effects.

This is a long dissertation but I am getting a lot manic with my new meds and it calms me down to sit here and type. I am not a psycho pharmacologist but I play one on TV. I am only talking about depression because that is what I have and know about. How Lamictal works or an anti psychotic I don't know. Might be very similar though.

Because your body and brain is connected in billions of ways in order to function and they think altering one thing or even ten things isn't going to effect something else.



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Has above, a strange drug has entered your body , so you body does battle against the intruder,