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Question

Could you comment on the following, "Before you begin taking any anti-depressant or ADHD treatment, or before you allow such a drug to be given to your child, insist that you or your child are tested for a properly-functioning CYP2D6 enzyme."

Dr. Eric

I was asked (off list) to comment on this post, so here goes. I'm not being critical of anyone, or of this information, but the post has a bit of "the sky is falling" quality to it. As with many of the posts that are on these scare sites, the post is based in fact, but it makes the problem sound much worse than it really is.

The fact is that there are differences among people in the way they metabolize drugs. The gene that this site is warning about, CYP2D6, is associated with various levels of metabolic activity, especially for anti-depressants. So far, these are all facts.Now, some additional facts that are NOT stated on the site. The incidence of those who have severe problems with metabolism of these drugs is extremely low. The problems will manifest themselves as a variety of side effects, so it is imperative that the patient is monitored closely by a competent physician.

I would NOT recommend that everyone who is taking anti-depressants be tested for the activity of this gene. I have two reasons for this opinion:

1) The rare occurrence of this genetic defect makes routine testing a waste of money for most patients. The testing is very expensive. It is considered experimental, so it is not covered by most insurance. There is no real "positive" result for the test; it must be interpreted along with the way the patient responds to the medication.

2) If you have taken anti-depressants in the past without serious side effects, you don't need to be tested. There are some people who SHOULD be tested. If you have ever had suicidal tendencies, especially if you were taking anti-depressants at the time, you should be tested. If there is a family history of depression, psychosis, or suicide, you should be tested. If you have ever had unusual reactions to any medication, you should be tested.

I have read several papers on this subject in the past few days, and I have talked to experts at our medical center. The evidence is far from
conclusive. One study from Germany showed that 3% of people had a defect in the gene, but fewer than 1 in 10,000 had side effects to treatment. A study from New Zealand showed that even in those with the defective gene, Prozac didn't cause any problems.My recommendation is this: if you need to take anti-depressants, be sure to have them prescribed by a competent PSYCHIATRIST. A psychiatrist is an MD who understands medical conditions, as well as psychological and psychiatric problems. If you are diagnosed by a psychologist, get another opinion from a real psychiatrist.Your psychiatrist should monitor your condition closely, especially in the first days that you are taking the new medication.

If you are told that you need to take an anti-depressant by an "alternative medical person", get another opinion from a real psychiatrist. Even if your chiropractor, naturopath, homeopath, shaman, Oriental healer, or other quack recommends a "natural" anti-depressant, like St. John's Wort, GET ANOTHER OPINION. And get that opinion from a real doctor, preferably a psychiatrist.Finally, don't be alarmed as you read a single web site that tells you that the sky is falling. ALWAYS get additional opinions. Everything that you read on the Internet should be taken with a LARGE grain of salt, and that goes for this post, too. If you don't like what you read here, get other opinions.The three most important pieces of advice regarding medical information:1) Ask your doctor.2) Ask another doctor.3) Ask for evidence, then listen to what your doctor (real doctor, not an alternative or a Ph.D.) tells you.


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