Good job Ana, we need to continue bringing these studies under the publics attention.
Patients should sign informed consents in which they are explicitly warned for the dangerous side effects.
The black box warning should be thoroughly explained: “you are sad now, you miss your husband who died, I can prescribe you medication that will blunt your emotions, but there is a risk you will kill your self or your children, or your depression gets worse, or you develop extreme restlessness, delusions, extreme fears, and movements that might not disappear when we discontinue the medication, but if that is what you want to do, please sign here.” How many people would sign up?????
Most of the cases I work on don’t go to trial. If they go to trial, it is still no guarantee I get paid. Sometimes I get paid only for the few hours I testify, not for the testing or the time it took to wrote the report. In 2 cases the court paid me for both.
CYPs are also expressed in the brain. We don’t know the levels of drugs in the brain.
If we know someone has polymorphisms which lead to altered levels in the blood, we also know that person has problems with levels in the brain, so we can adjust the dose or not give drugs at all.
The system of naming these enzymes is globally the same. That is why “pulpamor”, see below, had identical results in Mexico and the US. If she/he would go to China, the results would still be the same. I agree that doctors – and not only psychiatrists – prescribe way too much medications. By doing the CYP testing the damage might be reduced.
I can understand why you feel discouraged. But chance will come from the bottom up. If a patient or a family member speaks up, the prescribers have to listen. I have done many cases where patients or relatives warned their doctors the medication was making things worse. By asking for a CYP test they can force the doctors to become aware of the dangers involved in (any kind) of medication.
Educating the patients is just as important as education the prescribers. Both should be aware there are other, better ways to help people in psychological need. By doing the CYP testing as a doctor, or by demanding it as a patient, there is some objectifiable evidence why pharmacotherapy can go so horrible wrong. It is a way to prove the iatrogenesis.
Not all adverse drug reactions are dose related. Consensus is that the higher the level, the more chances of side effects from toxicity. But they can occur at low levels as well. When someone is in withdrawal and there are no levels of medication at all, the effect on the brain chemistry is still there.
With regard to violence the changing blood levels are very dangerous.
I totally agree. We don’t even know what a desirable level is or whether there is a desirable level. I recommend CYP testing to at least get an idea about what not to prescribe.
Many patients don’t want to go without drugs. Those are the ones that could benefit from testing, at least in the sense that they might not be put on medication that increases the changes of violence as side effect.
I use the CYP testing in cases where violence as a side effect had been occurred. From what I have learned so far it is clear that had testing been done the side effects were predictable.
Fair point! I seldom get paid for the work I do on a CYP investigation. I work for the defense, who’s clients are either in prison or in a psychiatric hospital. Sometimes the court pays or a client who can afford it, but most of the time I pay for the testing and the report from my own pocket. So I have no conflict of interest.
Good job Ana, we need to continue bringing these studies under the publics attention.
Patients should sign informed consents in which they are explicitly warned for the dangerous side effects.
The black box warning should be thoroughly explained: “you are sad now, you miss your husband who died, I can prescribe you medication that will blunt your emotions, but there is a risk you will kill your self or your children, or your depression gets worse, or you develop extreme restlessness, delusions, extreme fears, and movements that might not disappear when we discontinue the medication, but if that is what you want to do, please sign here.” How many people would sign up?????
Most of the cases I work on don’t go to trial. If they go to trial, it is still no guarantee I get paid. Sometimes I get paid only for the few hours I testify, not for the testing or the time it took to wrote the report. In 2 cases the court paid me for both.
CYPs are also expressed in the brain. We don’t know the levels of drugs in the brain.
If we know someone has polymorphisms which lead to altered levels in the blood, we also know that person has problems with levels in the brain, so we can adjust the dose or not give drugs at all.
The system of naming these enzymes is globally the same. That is why “pulpamor”, see below, had identical results in Mexico and the US. If she/he would go to China, the results would still be the same. I agree that doctors – and not only psychiatrists – prescribe way too much medications. By doing the CYP testing the damage might be reduced.
I can understand why you feel discouraged. But chance will come from the bottom up. If a patient or a family member speaks up, the prescribers have to listen. I have done many cases where patients or relatives warned their doctors the medication was making things worse. By asking for a CYP test they can force the doctors to become aware of the dangers involved in (any kind) of medication.
Educating the patients is just as important as education the prescribers. Both should be aware there are other, better ways to help people in psychological need. By doing the CYP testing as a doctor, or by demanding it as a patient, there is some objectifiable evidence why pharmacotherapy can go so horrible wrong. It is a way to prove the iatrogenesis.
Not all adverse drug reactions are dose related. Consensus is that the higher the level, the more chances of side effects from toxicity. But they can occur at low levels as well. When someone is in withdrawal and there are no levels of medication at all, the effect on the brain chemistry is still there.
With regard to violence the changing blood levels are very dangerous.
I totally agree. We don’t even know what a desirable level is or whether there is a desirable level. I recommend CYP testing to at least get an idea about what not to prescribe.
Many patients don’t want to go without drugs. Those are the ones that could benefit from testing, at least in the sense that they might not be put on medication that increases the changes of violence as side effect.
I use the CYP testing in cases where violence as a side effect had been occurred. From what I have learned so far it is clear that had testing been done the side effects were predictable.
Fair point! I seldom get paid for the work I do on a CYP investigation. I work for the defense, who’s clients are either in prison or in a psychiatric hospital. Sometimes the court pays or a client who can afford it, but most of the time I pay for the testing and the report from my own pocket. So I have no conflict of interest.