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Antipsychotics

Antipsychotic Medications in Schizophrenia

By | Antipsychotics, Pharmacogenetic Testing, Pharmacogenomics, Precision Medicine, Psychiatric Medications | No Comments

Medications are central to the treatment of schizophrenia and a number of drugs are used to treat this serious mental condition. Schizophrenia is a long-term mental disorder marked by psychosis- a breakdown in the relation between thought, emotion, and behavior, leading to errors in perception, inappropriate actions and feelings, withdrawal from reality, and a sense of mental fragmentation.

 

Most patients are now treated with antipsychotics that are thought to control symptoms through the brain chemical, dopamine. There are two types of antipsychotics used: first generation and second generation.

 

First Generation Antipsychotics

 
The first generation antipsychotics have more serious side effects and are used only when necessary. They include haloperidol (Haldol), chlorpromazine (Thorazine), and Fluphenazine (Prolixin). Side effects of first-generation antipsychotics include extrapyramidal side effects which is marked by rigidity, bradykinesia, dystonias, tremor, and akathisia. Tardive dyskinesia (TD)— a disorder marked by permanent involuntary movements in the limbs and face such as grimacing and lip-smacking – is another adverse effect that can occur with first-generation antipsychotics. Additionally. first-generation antipsychotics are known to cause cardiac rhythm abnormalities.

 

Second Generation Antipsychotics and Side Effects

 
The newer second generation antipsychotics have less side effects than the older drugs, and are preferred for treatment of schizophrenia. They include: aripiprazole (Abilify), asenapine (Saphris), brexipiprazole (Rexulti), clozapine (Clozaril), Iloperidone (Fanapt), Lurasidone (Latuda), Olanzapine (Zyprexa), Paliperidone (Invega), quetiapine (Seroquel), risperidone (Risperdal), and ziprasidone (Geodon).

 
Abilify side effects include akathisia (agitation), restlessness, insomnia, constipation, fatigue and blurred vision. Most of the second-generation antipsychotics have similar side effects, as they are similar chemically. Geodon is one of the newer antipsychotics with extra-pyramidal side effects reported (drug induced movement disorders).

 
During initial phases of treatment with the second generation antipsychotics patients may experience side effects such as dry mouth, drowsiness, restlessness, muscle spasms, tremor or blurring of vision. The second generation antipsychotics have a much lower risk of tardive dyskinesia, a serious side effect of the older antipsychotics. It is possible to lessen side effects by either lowering the dose or by changing medications.

 

Antipsychotic Pharmacogenetics

 
Patients and physicians often work together to find a dose that results in the fewest side effects. Patients will often change medications if the side effects are severe and side effects lessen over time. One way to potentially avoid side effects for new medications and for newly prescribed schizophrenia medications is to have your drug metabolism genes tested. After the human genome was sequenced back in 2003, genome wide association studies showed that there is variation among the population in the genes that process medications. As a result, if there’s a drug-processing gene with variation, it may have trouble processing medications that are metabolized by that gene product.

 

Know Your Risks with the Rxight® DNA Test

 
The most state-of-the-art way to determine genetic variations is with the Rxight® pharmacogenetics test from MD Labs. This advance in pharmacogenetics means that a physician can determine beforehand what drugs may be safe to take and what drugs to avoid or require different doses than recommended. All that is required is a prescription from a physician and a cheek swab at a participating pharmacy.

 
You could benefit from this advance in precision medicine with the knowledge of your gene variations with your physician or other healthcare services. The Rxight® pharmacogenetics test determines your genetic susceptibilities for over 200 drugs on the market. You could also benefit from knowing how you might respond to drugs you may have to take in the future. Most importantly, you could get information that may change your current dosing and medication for fewer harmful side effects from your antipsychotic medication.

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Overview of the Dangers and Side Effects of Psychotropic Medications

By | ADHD Medications, Antianxiety Medications, Antidepressants, Antipsychotics, Pharmacogenetic Testing, Precision Medicine, Psychiatric Medications | No Comments

Get the Rxight® Genetic Test to Know Your Risks

Psychiatric medications (often called “psychotropics”) are routinely used to treat a variety of psychiatric disorders – ranging from ADHD (attention deficit hyperactive disorder) and depression to bipolar disorder and anxiety to schizophrenia – Psychiatric medications are generally jused as an adjunct to psychotherapy.

 
It is estimated that 17 percent (some 80 million people) in the United States are taking some form of psychiatric medication (Scientific American, “1 in 6 Americans Takes a Psychiatric Drug,”  Dec 13 2016) According to the article, an earlier government report, from 2011, found that just over 10% of adults are taking prescription drugs for “problems with emotions, nerves or mental health,” published in the journal JAMA Internal Medicine.

 
While the potential benefits of psychotropic medications have been demonstrated in research and clinical practice for decades, patients are cautioned to remain vigilant of the many side effects of psychiatric medications.

 
This article presents a detailed summary of the major types of mental health medications and their associated risks for side effects as reported by the U.S. Food and Drug Administration (FDA) and the National Institute of Mental Health (NIMH) and an overview of the benefits of the Rxight® genetic test for psychiatric medications in identifying your unique genetically determined risk for developing side effects or non-response to dozens of these psychiatric medications along with hundreds of other medications across 50 pharmacological classes.

Antidepressant Side Effects

What are antidepressants?
Antidepressants are commonly used to treat depressive disorders. They also are used for other conditions, such as pain, anxiety and insomnia. Although antidepressants are not FDA-approved specifically to treat ADHD, they are sometimes used “off-label” for ADHD treatment.

The most commonly prescribed types of antidepressants today are called . Examples of SSRIs include:

Other types of antidepressants are serotonin and norepinephrine reuptake inhibitors (SNRIs) .These are chemically similar to SSRIs and include and duloxetine (Cymbalta)  and venlafaxine (Effexor).

 
Another antidepressant that is commonly used is bupropion – a third sub-class of antidepressant which acts differently than either SSRIs or SNRIs.  Bupropion is also used to treat seasonal affective disorder (SAD) and for smoking cessation treatment.

SSRIs, SNRIs, and bupropion are commonly used today because they do not cause as many side effects as the older (“first generation”) classes of antidepressants, and moreover are effective in treating a broader range of depressive and anxiety disorders.

 
Older antidepressant medications include tricyclic antidepressants, tetracyclic antidepressants, and monoamine oxidase inhibitors (MAOIs).  These are less commonly prescribed since the development of the newer generation antidepressants.
 
What are the possible side effects of antidepressants?
Some antidepressants may cause more side effects than others. The most common side effects listed by the FDA include:

  • Sexual problems (impotence or inability to orgasm)
  • Nausea and vomiting
  • Weight gain
  • Sleepiness or fatigue
  • Diarrhea

In 2004, the FDA ordered a “black box” label – the most serious warning it issues – on all antidepressants to caution of psychiatric drugs’ increasing suicide risk in children and adolescents. In 2006, the FDA increased the age to include young adults up to age of 25. (FDA, Revision to Product Labeling, 2004)

 
Call your doctor immediately if you have any of the following symptoms, especially if they are new, worsening, or worry you (U.S. Food and Drug Administration, 2011):

  • Suicidal thoughts or actions
  • New or worsening depression
  • New or worsening anxiety
  • Feeling restless or agitated or
  • Panic attacks
  • Insomnia
  • New or worsening irritability
  • Acting aggressively, being angry, or violent
  • Acting on dangerous impulses
  • An increase in activity and talking (mania)

Additionally, drug interactions can occur.  Specifically, combining the newer SSRI or SNRI antidepressants with one of the commonly-used “triptan” medications for treating migraines can cause a life-threatening condition called “serotonin syndrome.” Serotonin syndrome is marked by agitation, hallucinations, high temperature, or unusual blood pressure changes. Serotonin syndrome is usually associated with the older antidepressants called MAOIs, but it can happen with the newer antidepressants as well.

 
Antidepressants may cause other side effects that were not included in this list, as determined by individual genetics and ability to metabolize the drug in the liver.

 
How do patients respond to antidepressants?
Some people respond better to some antidepressant medications than to others.  It is critical to know that some people may not feel better with the first medicine they try. Additionally, sometimes people taking antidepressants feel better and stop taking the medication too soon, and the depression may return.

 
These inter-individual differences are based in genetics, and the Rxight® genetic test will indicate which antidepressants may not work for you right from the start instead of having to go through trial and error with your doctor  With Rxight results, you your doctor can work together to find the best and most effective antidepressant treatment tailored to your unique genetics.

 

Antipsychotic Side Effects

What are antipsychotics?
Antipsychotic medicines are primarily used to manage psychosis, a condition that affects the mind. Psychosis is characterized by some loss of contact with reality, often including or hallucinations (hearing or seeing things that are not really there), or delusions (false, fixed beliefs). It can also be a symptom of a physical condition such as drug abuse or a mental disorder such as schizophrenia, very severe depression (also known as “psychotic depression”), or bipolar disorder.

 
Antipsychotic medications are frequently used in combination with other drugs to treat delirium, dementia, and mental health conditions, including:

The older antipsychotic medications are conventionally referred to as “typical” antipsychotics or “neuroleptics”. Some of the common typical antipsychotics include:

Second generation antipsychotic medications are also called “atypical” antipsychotics. Some of the most common atypical antipsychotics are:

According to a 2013 research review by the Agency for Healthcare Research and Quality , typical and atypical antipsychotics both work to treat of bipolar disorder (preventing mania) and symptoms of schizophrenia Additionally, some atypical antipsychotics have wider applications and are used for treating bipolar depression or general depression.

 
What are the possible side effects of antipsychotics?

Antipsychotics are known to have a large number of side effects (also called adverse events) and risks, including potentially fatal complications.

 
The FDA lists the following side effects of antipsychotic medicines:

  • Constipation
  • Nausea
  • Vomiting
  • Uncontrollable movements, such as tics and tremors (the risk is higher with typical antipsychotic medicines)
  • Seizures Drowsiness
  • Blurred vision
  • Low blood pressure
  • Dizziness
  • Restlessness
  • Weight gain (the risk is higher with some atypical antipsychotic medicines)
  • Dry mouth
  • A low number of white blood cells, which fight infections

Typical antipsychotic medications can also cause additional side effects related to physical movement, such as:

  • Tremors
  • Restlessness
  • Rigidity
  • Muscle spasms

Long-term use of antipsychotic medications may lead to a condition called tardive dyskinesia (TD). Tardive dyskinesia causes uncontrolled muscle movements, commonly around the mouth. TD can range from mild to very severe, and in some people, the problem cannot be cured and becomes disfiguring.

 
Avoid the Risk of Antipsychotic Side Effects with Rxight®

The Rxight® medication panel includes 18 popular antipsychotics on the market. Because the potential side effects of both typical and atypical antipsychotics can be very serious and potentially fatal, knowing your risks ahead of time with Rxight® can be an invaluable test for you and your prescriber.

 

Mood Stabilizer Side Effects

What are mood stabilizers?
Mood stabilizers work by decreasing abnormal brain activity. They are used mainly to treat bipolar disorder and the mood swings associated with other mental conditions including:

  • Depression (usually in conjunction with an antidepressant)
  • Disorders of impulse control
  • Schizoaffective Disorder

Anticonvulsant (anti-seizure) medications are most frequently used as mood stabilizers. They were originally developed for treatment of seizures, but they were found to help control mood swings as well. One anticonvulsant commonly used as a mood stabilizer especially in patients with symptoms of both mania and depression, or those with rapid-cycling bipolar disorder, is valproic acid (sold as Depakote). Anticonvulsants used as mood stabilizers include:

Lithium is a non-anticonvulsant mood stabilizer approved for the treatment of mania and the maintenance treatment of bipolar disorder.

 
What are the potential side effects of mood stabilizers?

Mood stabilizers can cause several side effects, some of which may be serious, especially at high dosages. These side effects include:

  • Potentially fatal rash (Stevens-Johnson Syndrome)
  • Itching
  • Extreme thirst
  • Tremor
  • Nausea and vomiting
  • Fast, slow, or irregular heartbeat
  • Slurred speech
  • Blackouts
  • Changes in vision
  • Hallucinations
  • Loss of coordination
  • Swelling

Mood stabilizers may cause other side effects that are not included in this list. Your unique reaction to anticonvulsants is based in genetics, and the Rxight® genetic test will indicate which mood stabilizer not work for you may right from the start instead of having to go through trial and error with your doctor – a process which can be expensive, lengthy and dangerous.  With Rxight® results, you your doctor can work together to find the best and most effective antidepressant treatment tailored to your genotype, preferably before treatment begins.

 

Anti-Anxiety Medication Side Effects

What are anti-anxiety medications?
Anti-anxiety medications (also called “anxiolytics”) work by reducing the symptoms of anxiety, such as that seen in panic attacks, or extreme worry and fear. The most commonly prescribed anti-anxiety medications are called “benzodiazepines.” Benzodiazepines are most frequently used to treat a condition called generalized anxiety disorder, while in cases of social phobia (social anxiety disorder) or panic disorder (panic attacks). Benzodiazepines are usually second-line treatments, behind antidepressants such as SSRIS.

Benzodiazepines used to treat anxiety disorders – all of which are tested in the Rxight® panel – include:

Short-acting benzodiazepines such as Lorazepam and another class of medication known as beta-blockers are used to treat non-persistent symptoms of anxiety. Beta-blockers are used primarily to manage physical symptoms of anxiety (e.g., shaking, rapid heartrate, and sweating).

 
Buspirone  (which is chemically unrelated to the benzodiazepine family) is sometimes indicated for the long-term treatment of chronic anxiety. It is not effective to use on an “as-needed” basis like the benzodiazepines.

 
How common is addiction to benzodiazepines?
One of the serious risks of anti-anxiety medications is that you can build up a tolerance to benzodiazepines if they are taken over a long period of time and may need increasingly higher doses to get the same effect. There is a serious risk of addiction and dependence. To avoid these problems, doctors usually prescribe benzodiazepines for short periods, particularly in the elderly (NIMH, “Despite Risks, Benzodiazepine Use Highest in Older People”), and people with addiction tendencies. If people suddenly stop taking benzodiazepines, they may have withdrawal symptoms or their anxiety may return.

 
What are the possible side effects of anti-anxiety medications?
Like other medications, anti-anxiety medications may cause side effects, many of which are serious. The most common side effects of benzodiazepines are sleepiness and dizziness. Other possible side effects include:

  • Headache
  • Confusion
  • Tiredness
  • Nausea
  • Blurred vision
  • Nightmares

Tell your doctor immediately if any of these symptoms are severe or do not go away:

  • Drowsiness
  • Difficulty thinking or remembering
  • Increased saliva
  • Dizziness
  • Unsteadiness
  • Problems with coordination
  • Blurred vision

If you experience any of the symptoms below, call your doctor immediately:

  • Swelling of the eyes, face, lips, tongue, or throat
  • Difficulty breathing or swallowing
  • Rash
  • Hives
  • Hoarseness
  • Seizures
  • Yellowing of the skin or eyes (jaundice)
  • Depression
  • Difficulty speaking
  • Difficulty breathing

Common side effects of beta-blockers include:

  • Fatigue
  • Dizziness
  • Weakness
  • Cold hands

 

Stimulant Side Effects

What are Stimulants?
Stimulants increase alertness, attention, and energy, as well as elevate blood pressure, heart rate, and respiration. Stimulant medications are generally prescribed to treat individuals diagnosed with ADHD (attention-deficit hyperactivity disorder). People with ADHD who take prescription stimulants describe a calming and “focusing” effect from the medication.  This is due to its effects on the brain chemical dopamine.

Stimulants used to treat ADHD – all of which are analyzed in the Rxight® DNA test – include:

In 2002, the FDA approved non-stimulant medication atomoxetine (Strattera) for use as a treatment for ADHD. Additional non-stimulant antihypertensive medications, clonidine  and guanfacine, are also approved for treatment of ADHD.

In addition to treating ADHD, stimulants are prescribed to treat other health conditions, including narcolepsy, and occasionally depression.

 
What are the possible side effects of stimulants?
Stimulants may cause side effects, most of which are relatively minor and disappear when dosage levels are lowered. The most common side effects include:

  • Loss of appetite
  • Insomnia
  • Stomach pain
  • Headache

Less common side effects include:

  • Motor tics or verbal tics
  • Personality changes

What are serious side effects of stimulant medications?
While side effects of stimulant medications tend to be minimal, patients and parents of patients are cautioned that serious adverse effects may occur, as reported by the FDA Drug Safety Communication in 2013. Also see
FDA Warns of Psychiatric Adverse Events from ADHD Medications
.

 
Heart-related problems:

  • Sudden death in patients who have heart problems or heart defects
  • Stroke
  • Myocardial infarction (heart attack)
  • Increased blood pressure and heart rate

Mental (Psychiatric) problems:

  • Behavior and thought problems
  • New or worse aggressive behavior or hostility
  • New or worse bipolar illness
  • New psychotic symptoms (or new manic symptoms)
  • Physical or psychological dependence

For additional details on the FDA warnings and manufacturer labeling for medications covered in the Rxight® panel, please refer to our list of medications covered.

 

About Rxight® Pharmacogenetic Testing

The Rxight® genetic test analyzes your risks based on your unique genetic makeup through a process called “SNP genotyping.” The report which will be shared with you in a personal consultation with a pharmacist. The report “red-flags” medications which may cause you to have issues, or conversely highlight medications which may not be effective for you.

 
Rxight® is based on pharmacogenetics — the study of how genes affect a person’s response to medicines. Our panel of over 200 clinically significant medications includes dozens of commonly prescribed psychiatric medications, including antidepressants across five sub-classes, mood stabilizers used in bipolar disorder and schizoaffective disorder, antipsychotics, ADHD medications (stimulant and non-stimulant), and anti-anxiety medications.

 
Based on how well you metabolize those particular medications, which is determined by your genes that encode liver enzymes that break down drugs, you will be at risk for developing side effects or the medication not working well or at all. With the results of the Rxight® test you and your prescriber can find the right medication for you, preferably before treatment begins.

 
Contact us today by phone 1 (888) 888-1932 or email to learn more about how Rxight® pharmacogenetic testing can help you find the right medication, right from the start.

Co-Occuring Autism and Depression: A Clinical Challenge

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Is depression more common in patients with autism spectrum disorder (ASD) than in the general population? Yes, according to research on the co-morbidity of mood disorders and ASD – which according to the CDC affects an estimated 1 in 45 children in the U.S.
 
An article published in Dialogues in Clinical Neuroscience, “Challenges in the diagnosis and treatment of depression in autism spectrum disorders across the lifespan” (2015), found that some research points to rates of depression as high as 57 percent in ASD patients. One study of adult patients found the rate of suicide of ASD adults was almost 2 percent, compared to less than.5 percent of adults without autism.
 

Clinicians Face Difficulties Differentiating between Depression and ASD

 
It can be difficult to differentiate between symptoms of autism and those of depression. In fact, diagnosing depression in those with autism represents a clinical challenge that dates back to Leo Kanner’s original description of the condition in his 1943 paper where he identified that individuals with autism spectrum disorders show little facial emotion – called a “flat affect.” However, in autism, affect doesn’t necessarily correspond to the individuals’ mood, which is an internal state not always congruent with emotion.
 
Another challenge that clinicians face in diagnosing depression in patients with autism is the overlap in symptoms. Those of depression typically include a flat facial expression as with autism, reduced appetite, sleep disturbance, low energy, reduced motivation, social withdrawal and reduced desire to communicate with others. Many of these same symptoms can stem from autism rather than depression.
 

Find the Right Medications with Rxight® Pharmacogenetic Testing

 
Two drugs for treating the irritability and aggression that is commonly associated with the autism – risperidone (Risperdal) and aripiprazole (Abilify) – have been approved by the Food and Drug Administration. Additionally, so-called “off-label” medications include naltrexone, which is FDA-approved for the treatment of alcohol and opioid addictions. It can ease disabling repetitive and self-injurious behaviors. (Autism Speaks, “Medicines for Treating Autism’s Core Symptoms”).
 
MD Labs’ CLIA-certified Rxight® genetic testing panel – which among the most comprehensive available – includes risperidone and aripiprazole, along with 26 antidepressant medications across clinically significant antidepressant classes. Over 200 other medication are also covered in the Rxight® panel.
 

Your Insurance May Cover Testing with Rxight®

 
Many insurance companies now cover tetrabenazine (Xenazine), nortriptyline (branded as Pamelor and Aventyl Hydrochloride) and amitriptyline (branded as Elavil, Endep and Vanatrip), antidepressants within the Rxight® panel.
 
If you or a loved one suffers from depression and has been diagnosed with ASD as well, ask your doctor about authorizing the Rxight® Pharmacogenetic Test. Genetic testing with Rxight® enables you and your prescribers to know – preferably ahead of time – which medications may causes potentially dangerous adverse reactions and conversely which may be ineffective.
 
To get started, we invite you to email us today or call 1-888-888-1932 to discover how you may benefit from our pharmacogenetic testing program.

Bipolar Medication Side Effects

By | Adverse Drug Reactions, Antipsychotics, Psychiatric Medications | No Comments

Many medications on the market are prescribed for bipolar disorder, and many more are prescribed ‘off label’ for bipolar disorder.  The medications designated for bipolar disorder include Seroquel (quetiapine, an atypical antipsychotic), Zyprexa (olanzapine, an atypical antipsychotic) Latuda (lurasidone, an atypical antipsychotic), Prozac and its generic equivalents (selective serotonin reuptake inhibitors or SSRIs), Silanor (doxepin, a TCA), Symbyax (Prozac and Zyprexa) and lithium. Many clinicians are now prescribing serotonin and norepinephrine reuptake inhibitors (SNRIs) for bipolar disorder as well.  Some of the common SNRIS are Effexor (venlafaxine), Pristiq (Desvenlafaxine), and Cymbalta (duloxetine).  Lithium (Eskalith, Lithobid) remains one of the most widely prescribed medications for treating bipolar disorder.  Lithium is a chemical element formulated for oral use.

 

How Bipolar Medications Work

 
Each of these medications works differently in the central nervous system but are all prescribed to relieve the symptoms of bipolar disorder.  Lithium is thought to strengthen nerve cell connections in brain regions that are involved in regulating mood, thinking and behavior.  Like most bipolar medications, lithium takes several weeks to start working effectively.  Lithium can affect kidney or thyroid function so that periodic blood tests should be taken throughout your treatment with lithium.  Studies show that lithium can reduce suicide risk, and help prevent future manic and depressive episodes.

 

Atypical Antipsychotics

 
The atypical antipsychotics are considered to be second generation antipsychotics (SGAs) as they are a newer class of pharmaceuticals with a profile that is different from the older antipsychotics. These medications are most commonly used to treat acute mania and mixed episodes, often in tandem with mood stabilizers such as lithium or valproate. Both quetiapine and olanzapine have shown significant efficacy in all three treatment phases of bipolar disorder. Lurasidone (trade name Latuda) has shown some efficacy in the acute depressive phase of bipolar disorder.

 

The SGAs act on many receptors, but are more selective for the dopamine receptors.  They appear to be more effective in treatment-resistant patients and have the advantage of fewer side effects than the older antipsychotics, although there are still the serious extrapyramidal side effects such as unsteady Parkinson’s like movements, body rigidity and involuntary tremors.  Other side effects include neuroleptic malignant syndrome, sudden cardiac death, blood clots, diabetes, and increased risk of stroke.

 

Neuroleptic Syndrome

 

Neuroleptic syndrome is a serious, life-threatening neurological condition caused by an adverse reaction to SGAs. Symptoms include high fever, stupor, muscle rigidity, unstable blood pressure, and autonomic dysfunction.   Some researchers believe that the term ‘second generation antipsychotics’ should be abandoned because of the range of side effects actually reported.  Another side effect may be significant weight gain.  Open discussion with your provider should include your medical history and every drug or supplement you are taking.

 

SSRIs

 

The selective serotonin reuptake inhibitors (SSRIs) are a different pharmacological class of drugs, first prescribed for major depressive disorder. They are considered to be third generation antidepressants.     The exact mechanism is not known, however, it is thought that the when the medication prevents reuptake of serotonin in the brain it results in relief of symptoms.  Controversy surrounds the use of SSRIs in the treatment of bipolar disorder, as twenty years of research suggest that antidepressants induce mania or accelerate cycling in a small minority of patients. This is a lower number than previously suggested, although questions remain.

 

Teratogenics

 
These drugs are not recommended for pregnant women.  Side effects of SSRIs include: commonly reported cases of drowsiness, dry mouth, nausea, diarrhea, insomnia, dizziness, nervousness, agitation, restlessness, and sexual problems.

 

Tricyclic Antidepressants

 

Doxepin (Sinequan, Silanor are some brands) is known as a dibenzoxepin tricyclic drug in the general class of tricyclic antidepressants (TCAs). It is marketed worldwide under many brand names.  Known contraindications include glaucoma, a predisposition to developing urinary retention, use of MAO inhibitors, or hypersensitivity to other tricyclic antidepressants.  The adverse effects include the central nervous system symptoms such as fatigue, dizziness, drowsiness, agitation, insomnia, seizures, delirium, rarely induction of hypomania and schizophrenia (stop medication immediately), and rarely, extrapyramidal side effects.

 

Other side effects include dry mouth, difficulties in urinating, constipation, sweating, and precipitation of glaucoma.  Additional side effects include increased appetite, weight gain, impaired sexual function in men, and rarely hypertension.  There may also be a negative effect on the liver.

 

SNRIs

 

The serotonin and norepinephrine reuptake inhibitors (SNRIs) are a relatively new class of antidepressants also prescribed for bipolar disorder.  They are typically prescribed for major depressive disorder and are considered by some to be superior to the SSRIs because of the ‘dual uptake’ presumed mechanism of action.   Most common side effects of SNRI’s include dizziness, nausea, and sweating.

 

Some SNRIs may cause sexual dysfunction, and other side effects include constipation, tiredness, anxiety, headache, insomnia and loss of appetite.  Some SNRIs are associated with an increased risk of suicidal behavior in children and young adults.

 

Genetic Testing

 
Because of the wide range of medications used to treat bipolar disorder there is significant decision making power in the hands of the physician.  Often drugs are prescribed through a trial and error which can be effective but can also be costly and user may suffer adverse reactions.

 

Many side effects may be the result of specific genetic variations in your genome (your individual collection of genes in your chromosomes).  Pharmacogenetic research has shown that the varying responses too many drugs on the market are due to variations in the genes that code for the enzymes or other molecules targeted in the medication.  Variation in a particular gene means that the enzyme or protein is varied as well, and may not work as well or at all in its normal function, which is to metabolize (process) the drug.    The Rxight® pharmacogenetic test from MD Labs is designed to test and measure your individual response to over 200 drugs on the market.  With this knowledge, you and your physician can decide which drugs are safe for you to take, or what doses are appropriate for your genetic makeup.

 

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Genetic Testing for Psychiatric Medications

By | Antipsychotics, Pharmacogenetic Testing, Psychiatric Medications | No Comments

Psychiatric medicines are an important component of treating neurological and mental health disorders including depression, attention deficit disorder and schizophrenia. Dosing of psychotropic drugs can be challenging for the clinician because there is considerable variability in patient response to a drug. This variability is due to a number of reasons including the severity of disease being treated, diet, age and interactions with other medications.  The finding were published in Psychiatry Journal “The Potential Utility of Pharmacogenetic Testing in Psychiatry” (2014).

 

Inherited genetic variants also affect the way that a drug is metabolized. Some patients experience side effects from a medicine while others may not get any therapeutic value at all. For example, up to 40 percent of patients prescribed the drug fluoxetine for depression, do not get any benefit from the medicine.  The findings were published inCurrent Psychiatry Review “Jumping on the Train of Personalized Medicine: A Primer for Non- Geneticist Clinicians: Part 3. Clinical Applications in the Personalized Medicine Area” (May 2014).
 

Importance of Pharmacogenetic Testing for Psychiatric Medicines

 
Because of the variability in patient response and the potential for adverse reactions to a drug, clinicians have traditionally used a cautious trial and error method to select an appropriate medicine and determine optimum dosing. Although this approach minimizes side effects, it also delays the amelioration of symptoms. In an effort to relieve symptoms, physicians may use several medications. Combinations of drugs may result in over medication or cause side effects due to drug interactions.  The findings were published in Dialogues in Clinical Neuroscience “Psychiatric pharmacogenomic testing in clinical practice” (Mar 2010).

 

Pharmacogenetic testing provides doctors with an important tool that helps determine which medicines are best suited to a patient’s unique medical condition. Variants of several genes are associated with differences in metabolism of psychiatric medications. Gene CYP2D6 is one of the most important phenotypes for psychiatric medicines. Amitriptyline, several antidepressants and several antipsychotics are metabolized by this gene. Other clinically important genes include CYP2C19, CYP2C9 and CYP1A2. Variations in these genes affect serum concentrations of medications which, in turn, influence drug effectiveness and the potential for adverse medication reactions.  The findings were published in Dialogues in clinical neuroscience “Psychiatric pharmacogenomic testing in clinical practice” (Mar 2010).

 

So-called poor metabolizers assimilate medicines more slowly. The low metabolic capacity may cause toxicity or result in adverse events. Ultra-rapid metabolizers eliminate the drug too quickly and these patients are less likely to derive a therapeutic benefit. Intermediate metabolizers are at a higher risk of developing drug-drug interactions. The Food and Drug Administration has issued warning and dosage recommendations for more than 30 psychiatric medicines for patients with specific genetic variants. For example, citalopram require dosage modifications for ultra-rapid metabolizers.  The findings were published in:
Dialogues in clinical neuroscience “Psychiatric pharmacogenomic testing in clinical practice” (Mar 2010; Table of Pharmacogenomic Biomarkers in Drug Labeling as reported by the FDA (Nov 2016); Current Psychiatry Review “Jumping on the Train of Personalized Medicine: A Primer for Non- Geneticist Clinicians: Part 3. Clinical Applications in the Personalized Medicine Area” (May 2014).

 

Rxight® Pharmacogenetic Testing

 
The FDA recommends  pharmacogenetic testing before administering several psychotropic medications to minimize side effects and improve therapeutic outcomes. Rxight® pharmacogenetic testing examines a patient’s DNA to identify genetic variants on 60 alleles of 18 clinically significant genes that affect drug metabolism. The test covers approximately 200 prescription medicines including psychiatric medicines listed by the FDA.

 

Patients receive a personalized medication report. The information is interpreted by a pharmacist trained in pharmacogenetics. Pharmacists coordinate with a patient’s physician to help determine a medication and dose that has the potential for greater efficacy and lower risk of adverse effects. Adherence to a drug therapy program is of particular importance for patients with psychiatric disorders. When patients know that the potential for unpleasant side effects is reduced, they may become more confident in the safety of the treatment and gain better value from the medications. The findings were published in Pharmacotherapy “Pharmacogenomic Testing for Neuropsychiatric Drugs: Current Status of Drug Labeling, Guidelines for Using Genetic Information, and Test Options” (Feb 2014).

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CYP2D6 Polymorphisms and Risperidone Treatment

CYP2D6 Polymorphisms and their Influence on Risperidone Treatment

By | Antipsychotics, Provider, Psychiatric Medications | No Comments

The clinical utility of genomic profiling in risperidone pharmacotherapy was discussed in Pharmacogenomics and Personalized Medicine “CYP2D6 polymorphisms and their influence on risperidone treatment” (Dec 2016). Risperidone (Risperidal) is an atypical antipsychotic (AAP) drug that is indicated for the treatment of autism, schizophrenia, and acute bipolar mania. It exerts its pharmacologic effects by binding to and inhibiting serotonin and dopamine receptors.

 

Risperidone is metabolized by hepatic metabolism via the CYP2D6 enzymatic pathway to its major active metabolite 9-hydroxyrisperidone and therapeutic response and likelihood of risperidone side effects based on plasma concentrations of risperidone and its metabolite. According to the investigators, several studies suggested that CYP2D6 polymorphisms were associated with these plasma concentration. Hence, CYP2D6 poor metabolizers showed more serious adverse events such as weight gain and prolactin than other predicted phenotype groups.

 

According to researchers, “As the knowledge of pharmacogenomics of CYP2D6 in risperidone treatment is increasing, it can be used for the development of personalized medication in term of genetic-based dose recommendation,” and advocated for future research into genetic-based risperidone treatment.

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Clozaril Black Box Warning

By | Antipsychotics, Provider, Psychiatric Medications | No Comments

Clozaril (generic name clozapine) is an atypical antipsychotic approved to treat schizophrenia. The drug is also used “off-label” to treat bipolar disorder and schizoaffective disorder. While it can be effective in treating the symptoms of schizophrenia, the drug may cause severe and sometimes life-threatening side effects.

 

FDA “Black Box” Warning for Numerous Side Effects

 

Certain Clozaril side effects are so harmful to the person, that they have prompted a special warning by the FDA called a “black box” warning. In fact, clozapine has five black box warnings:

 

  • Agranulocytosis
  • Seizures
  • Myocarditis and cardiomyopathy
  • Orthostatic hypotension, bradycardia, syncope
  • Increased risk of death in elderly patients with dementia

 

Agranulocytosis

 

Agranulocytosis is a disorder of the blood in which there are too few white blood cells. This side effect of clozaril is also referred to as neutropenia. White blood cells are a key component of the immune system. As such, people with neutropenia are at an increased risk for infections. This side effect of clozapine is with such seriousness, that people who receive clozapine must have their blood tested for neutropenia periodically. In fact, clozapine is only available through a distribution system that ensures blood monitoring. If neutropenia does occur, clozapine is stopped and white blood cell count returns to norm level.

 

Seizures

 

One of the major neurological Clozaril side effects is seizures. Seizures are abnormal increases in brain activity that may lead to uncontrollable physical movements, convulsions, and loss of consciousness. People who have a history of seizures, have epilepsy, or any condition in which seizures may occur, are often not able to take clozapine because of this ornery physical reaction.

Clozapine lowers the seizure threshold. This effect seems to be dose dependent. In other words, the risk of seizure increases as the dose of Clozaril increases.

 

Myocarditis and Cardiomyopathy

 

Myocarditis and cardiomyopathy are related conditions that involve inflammation of the heart and cause damage to the heart muscle. These conditions can be fatal. Clozaril adverse effects are more likely to occur within the first month of starting the drug. There is a small risk of myocarditis and cardiomyopathy at any point when the drug is use. If signs or symptoms of the Clozaril side effects occur, talk to your doctor and stop taking the medication.

 

Orthostatic Hypotension, Bradycardia, Syncope

 

These clozapine adverse effects are interrelated. The drug may decrease both heart rate and blood pressure, especially when someone rises from a seated or reclining position. When there is not enough blood flow to the brain, patients may become lightheaded (pre-syncope) or actually faint (syncope). These Clozaril side effects are most likely to occur when the drug is started or the dosage is changed.

 

Increased Risk of Death in Elderly Patients with Dementia

 

Atypical antipsychotics (including Clozaril), increase the risk of death in elderly patients with dementia. Dementia is a condition that causes hallucinations and delusions. As such, clozapine is usually not used to treat dementia-related psychosis.

 

Other Clozaril Side Effects

 

Compared to black box warnings, other Clozaril side effects are relatively minor. The most common Clozaril adverse effects are tachycardia (rapid heart rate), drowsiness, dizziness, insomnia, weight gain, nausea, vomiting, constipation, and sialorrhea (drooling or excessive saliva production).

 

To have an understanding on how you will react to Clozaril, preferably before using it, PGx testing with Rxight® can provide the solution. The Rxight® panel also includes hundreds of other medications across over 50 pharmacological classes.

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Psychiatric Medication Side Effects

By | ADHD Medications, Adverse Drug Reactions, Antipsychotics, Drug Metabolism, Psychiatric Medications | No Comments

Learn More about Our Genetic Test to Find Your Risks for Side Effects

Almost 79 million Americans use some form of psychotropic drug. Psychiatric medications include antidepressants, antipsychotics, anti-anxiety drugs, mood stabilizers and stimulants used to treat mental health conditions such as anxiety, depression, attention deficit disorder and schizophrenia. Some are used for non-psychological ailments including pain and neuropathy.

 

Common Side Effects of Psychiatric Medications

Most psychiatric drugs have side effects, although not every patient experiences adverse effects. Common side effects include blurred vision, headaches, nausea and drowsiness. A small percentage of patients experience severe or life-threatening adverse reactions such as fever, seizures or difficulty breathing. These drugs must be used under the supervision of a clinician. Patients must strictly adhere to prescription protocols to avoid side effects, drug interactions or withdrawal symptoms.

 

Adverse reactions to psychiatric drugs occur for a number of reasons including diet, type and severity of disease and use of other medications. Some reactions occur because of a person’s unique genetic makeup. Studies demonstrate that particular genes affect the metabolism of specific medicines. Pharmacogenetics looks at the way an individual metabolizes and responds to drugs. Knowing a patient’s genetic characteristics allows clinicians to select medications that have the greatest therapeutic value and minimize adverse drug events.

 

Antidepressants Side Effects

 

Antidepressants are used to treat several conditions including depression, anxiety, pain, smoking cessation, neuropathic pain and sleep disorders. These drugs correct chemical imbalances in the brain. Neurotransmitters, chemicals produced by nerve cells in the brain that communicate with one another, include dopamine, gamma-aminobutyric acid, norepinephrine and serotonin. Antidepressants inhibit chemical imbalances and enhance communication between cells.

 

Older antidepressants include monoamine oxidase inhibitors such as selegiline, tetracyclics such as mirtazapine and tricyclics such as amitriptyline. MAOIs may produce side effects such as muscle cramps, low blood pressure and weight gain. MAOIs also interact with certain foods, so dietary restrictions are necessary. Common side effects of tricyclics and tetracyclics include constipation, dizziness and dry mouth. More serious side effects include thoughts of suicide, vomiting and hives.

 

Newer antidepressants include serotonin reuptake inhibitors such as fluoxetine and sertraline, and serotonin and norepinephrine reuptake inhibitors such as duloxetine and bupropion. These drugs are more commonly prescribed because they produce fewer adverse reactions. Side effects of SSRIs and SNRIs include agitation, sweating and abnormal thinking. These drugs should not be combined with other medicines or herbs that increase serotonin levels in the brain such as older antidepressants, St. John’s Wort or amphetamines. Drug interactions may cause a life-threatening condition called serotonin syndrome or gastric bleeding.

 

Clinicians typically prescribe antidepressants by trial and error to determine whether a patient will suffer adverse reactions and find a dosage that controls symptoms while minimizing side effects. When patients suffer side effects or do not get relief, the doctor may change medicines. Antidepressants should be stopped only under the guidance of a healthcare professional to avoid relapse or serious side effects.

 

Anti-Anxiety Drugs Side Effects

Anti-anxiety medicines are used to treat anxiety disorders such as panic attacks, phobias and excessive worry. Most medicines in this category are benzodiazepines such as clonazepam, chlordiazepoxide and diazepam. Beta-blockers such as propranolol and antihistamines such as hydroxyzine are also used to treat anxiety. Like depression, anxiety disorders often occur because of chemical imbalances in the brain. Although these medicines cannot cure the disorders, they can provide relief from symptoms. Benzodiazepines target GABA transmitters, while antihistamines provide a sedative effect. Beta-blockers ease anxiety such as stage fright or post-traumatic stress. Anticonvulsants such as gabapentin and topiramate are often used to augment therapy.

 

Each of these medications may produce minor side effects such as dizziness, fatigue or drowsiness. Benzodiazepines are usually used on a short-term basis because they can be habit-forming. They should not be stopped abruptly because of the risk of side effects and seizures or be combined with alcohol or other central nervous system depressants. Beta-blockers should not be used by people with asthma or diabetes. Some anticonvulsants like topiramate are associated with visual changes and decreased sweating. Anticonvulsants should be stopped gradually to avoid the risk of seizure. Combining anti-anxiety drugs with other medications should be done only under the guidance of a physician to avoid serious side effects from drug interactions.

 

Side Effects of Antipsychotics

 

Antipsychotics are used to manage mental disorders including psychosis, schizophrenia, delirium and dementia. Antipsychotics block dopamine receptors. Older medicines, called “typical” antipsychotics or neuroleptics, include chloropromazine and haloperidol. Newer drugs, called “atypical” antipsychotics, act on both dopamine and serotonin receptors. Atypical antipsychotics include risperidone and lurasidone. Common side effects of atypical
antipsychotics include tremors, seizures, constipation and restlessness. Typical antipsychotics may also impair movement or cause rigidity or muscle spasms. Long-term use may cause tardive dyskinesia, or uncontrollable movements around the mouth. Antipsychotics should not be stopped abruptly to avoid withdrawal symptoms.

 

Stimulants Side Effects

 

Stimulants increase heart rate, attention and blood pressure. They are used to treat attention deficit hyperactivity disorder, depression and other health conditions. Medicines used to treat ADHD include dextroamphetamine and methylphenidate. Common side effects include sleeplessness and loss of appetite.

 

Mood Stabilizer Side Effects

 

Mood stabilizers are used to treat mood swings and bipolar disorder. They may also be used with other psychiatric drugs to treat other mental health problems. Lithium is commonly used for these disorders. Anticonvulsants such as carbamazepine and valproic acid are also used. Side effects include itching, blackouts, seizures or loss of coordination.

 

Pharmacogenetic Testing and Adverse Drug Reactions

 

Pharmacogenetic testing examines a patient’s DNA to identify gene variants that can affect the metabolism of drugs. The cytochrome P450 family of genes metabolizes most psychiatric drugs. Genetic variations can affect the rate of metabolism. Slow metabolism may result in adverse side effects. Rapid metabolism may eliminate a drug too quickly and reduce the therapeutic value.

 

Some genes affect the metabolism of antipsychotic medicines that bind with dopamine. Other genes affect how SSRIs are assimilated. Some variants are common to particular ethnic groups; others are individual. Studies show that particular genotypes had a 50 percent higher risk of developing tardive dyskinesia. Another genetic variant is associated with a reduced risk of TD, suggesting the gene may protect from developing TD. Drugs such as clozapine that bind with serotonin receptors are associated with lower incidences of TD.

 

Gene CYP2D6  metabolizes several antidepressants and approximately 40 percent of antipsychotics including risperidone and haloperidol. Poor metabolizers of CYP2D6 are more likely to suffer side effects from several commonly prescribed antipsychotics. Genotyping for CYP2D6 can help predict metabolic responses for several antidepressants and neuroleptics. The Food and Drug Administration has issued drug label warnings and dosing recommendations for specific genetic variants for several psychiatric drugs including clozapine, risperidone and amitriptyline.

 

Clinicians and pharmacists trained in pharmacogenetics can help patients understand the potential for adverse effects of psychiatric drugs that may be due to genetic variants. When testing results are included in a patient’s medical records, pharmacists can verify that medications are appropriately dosed and communicate information about how to use the drug to patients. Reducing side effects makes patients more confident about the medications prescribed by their doctors, which can increase patient adherence to drug therapy regimens.

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