Archive for the ‘Links and Resources’ Category

Genomind

Genetic Testing

Genomind

 

The Genecept Assay Test Panel at a Glance

Pharmacodynamic

GENE PHYSIOLOGICAL ROLE IMPACT OF MUTATION TREATMENT IMPACT
Serotonin Transporter
(SLC6A4)
Protein responsible for reuptake of serotonin from the synapse Inhibition of this protein by SSRIs,
which may lead to increased risk for non-response/side effects
Use caution with SSRIs; atypical antidepressants or SNRIs may be used if clinically indicated
Calcium Channel
(CACNA1C)
A subunit of the calcium channel which mediates excitatory signaling Associated with conditions characterized
by mood instability/lability
Atypical antipsychotics, mood stabilizers, and/or
omega-3 fatty acids, which may help to reduce excitatory signaling, may be used if clinically indicated
Sodium Channel
(ANK3)
Protein that plays a role in sodium channel function and regulation of excitatory signaling Associated with conditions characterized
by mood instability/lability
Mood stabilizers and/or omega-3 fatty acids, which may help to reduce excitatory signaling, may be used if clinically indicated
Serotonin Receptor 2C
(5HT2C)
Receptor involved in regulation of satiety Blocked by atypical antipsychotics,
resulting in metabolic side effects
Use caution with atypical antipsychotics; inositol may be used to mitigate risk for weight gain if clinically indicated
Melanocortin 4 Receptor
(MC4R)
Receptor that plays a role in the control of food intake Increased risk for weight gain and higher BMI, which is exacerbated by atypical antipsychotics Use caution with atypical antipsychotics
Dopamine 2 Receptor
(DRD2)
Receptor affected by dopamine in the brain Blocked by antipsychotic medications and is associated with risk for non-response/side effects Use caution with antipsychotics
Catechol-O-Methyltransferase
(COMT)
Enzyme primarily responsible for the degradation of dopamine in the frontal lobes of the brain Altered dopamine states can have emotional/behavioral effects and impact response to dopaminergic agents Dopaminergic agents or TMS may be used if clinically indicated for Val/Val patientsUse caution with dopaminergic agents in
Met/Met patients
Alpha-2A Adrenergic Receptor
(ADRA2A)
Receptor involved in neurotransmitter release Associated with improved response to stimulant agents Stimulant agents may be used if clinically indicated
Methylenetetrahydrofolate Reductase
(MTHFR)
– A1298C
– C677T
Predominant enzyme that converts folic acid/folate to its active form (methylfolate) needed for synthesis of serotonin, dopamine, and norepinephrine Associated with varied activity and conversion of folic acid/folate to methylfolate Supplementation with L-methylfolate may be used if clinically indicated
Brain-derived
Neurotrophic Factor
(BDNF)
Important for proper neuronal development and neural plasticity Impaired BDNF secretion, which may be associated with altered SSRI response in Caucasians Increased physical activity/exercise may be beneficial for Met carriers if clinically indicated
μ-Opioid Receptor
(OPRM1)
Opioid receptor affected by natural and synthetic compounds Activated by opioids and associated with varied analgesic response, dosage, and abuse/addiction risk Use caution with opioids; non-opioid analgesics may be used if clinically indicated
Glutamate Receptor
(GRIK1)
An excitatory neurotransmitter receptor in the brain Associated with response to topiramate for alcohol abuse Topiramate may be used for treatment of alcohol abuse if clinically indicated

 

Pharmacokinetic

GENE PHYSIOLOGICAL ROLE IMPACT OF MUTATION TREATMENT IMPACT
CYP450
(CYP1A2, CYP2B6, CYP2C9, CYP2C19, CYP2D6, CYP3A4/5)
Enzymes that metabolize medications in the liver Large number of psychiatric medications are metabolized by CYP450s Dose adjustment (an increase or decrease) may be required

 

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Cleveland Heart Labs

Learn More about the comprehensive labwork Dr. Jones recommends for our patients!

Home

 

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Eat Fat Get Thin

“Everyone seems to be talking about fat these days. That fat somehow is good now and can help with weight loss and disease prevention.  How can that be true when for decades we all were told that fat was the bad guy?” asks this week’s house call. “What are its benefits? Are there any downsides to eating more fat?”

To see full article visit: http://drhyman.com/blog/2015/12/27/separating-fat-from-fiction-10-fat-facts-you-need-to-know/

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Perlmutter’s Guide to the Glycemic Index

Perlmutter’s Guide to the Glycemic Index

Whether you are sick, well, overweight, metabolically compromised, experiencing brain issues, or just want to preserve your mental wellbeing, understand that the Glycemic Index plays a pivotal role.  Choose foods with a lower GI while making sure they are gluten-free. This will maintain healthy levels of blood sugar and insulin. These are the keys to enhancing general health as well as brain health and function.

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We Will Remember Siggie – 2000-2013 RIP!

Pets play a major and significant role in our lives.

Many studies have indicated that having a pet in the home is particularly good for elderly people that live alone.  They become a part of our family.  Our Bassett Hound, named of course, Sigmund (but we called him Siggie,) died June 15th.  He was 13 years old.  Needless to say, our whole family, especially our daughter that raised him, miss him and have gone through a true grieving process over his loss.  Some people don’t think that their grief over a pet is appropriate, and/or embarrassing.  The truth of the matter is that grief helps us heal after losing a beloved pet, and we should all allow that process to happen.  Most of us will outlive our pets, so losing them at some point in time is usually inevitable.

Dr. Jones has always been amazed at how many pet owners do not think they should be devastated over the loss of a pet.  It is perfectly normal to grieve and to miss them, just like any family member that is lost!  He always assures them that it is okay and normal to be upset over their loss!

I am attaching our tribute video to Siggie.  I hope you enjoy it!      RIP Siggie, we love you!

http://video214.com/play/nUjXSEF4KERjetBHXgVG0w/s/dark[spider_facebook id=”- Select Form -“]<div class=”fb-like”” data<href=”http://developers,facebook.com/docs/reference/plugins/like”

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ADHD Resources

Book/Audio Suggested Reading:

  • Shadow Syndromes, by John Ratey, M.D.
  • Driven to Distraction, by Edward Hollowell, M.D.
  • Women With Attention Deficit, by Sari Solden
  • Crazy Busy, by Edward Hollowell, M.D.
  • Taking Charge of Adult ADHD, by Russell Barkley, PhD
  • Straight Talk about Psychiatric Medications for Kids, by Timothy Wilens, M.D.

Online resources:
http://www.chadd.org/
http://www.add.org/
http://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml
http://www.mayoclinic.com/health/adhd/DS00275
http://www.russellbarkley.org/
http://www.drhallowell.com/

 

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Perspectives by Penny – ADHD

ADHD… Perspectives by Penny

I hope I can accomplish through the privilege of writing this blog helping someone gain more insight into understanding the challenges of living with ADHD every day.

And I have to put this disclaimer in: these are all my opinions, not those of Dr. Jones.

“Our future lies in the hands of the creatively maladjusted” Martin Luther King Jr.

04-30-2013

Blog Entry 1 Introduction

I have worked with Dr. Jones for 17 years, gone to most of the CME courses he attends (continuing medical education), which has been literally hundreds of hours, and have a bachelors degree in Psychology and Marketing. I have developed slides for his presentations, as well as edited and help write his newsletters and website. I have also been on the board of directors of the Dallas chapter of CHADD which is a national ADHD organization. Their website is: http://www.chadd.org/

I think I have an extremely unique, multi-faceted slant on ADHD and stress related mental health issues. (I have also seen the pharmaceutical company industry very up close and personal concerning neuropsychiatric drugs.) So, I am starting my first blog with that subject specifically.

I have known and interacted with many physicians that treat ADHD. I have also had direct contact with the pharmaceutical companies all the way down the chain of hierarchy from their ivory tower corporate executives (they get the really big money), the specialists with “big credentials that answer questions for the few doctors that inquire”, the regional managers, and then the pharmaceutical reps that really work in the trenches with doctors and see the real world that clinical physicians deal with everyday.

I have attended countless meetings and conferences, including: data and research updates on new drug studies, pharmaceutical company “launches” of new products, physician speaker training meetings, and reviewed endless studies of medications relevant to treating psychiatrically related issues.

Because of negative press, the pharmaceutical industry has made an attempt to “self police” by creating PhRMA (Pharmaceutical Research and Manufacturers of America). This self-regulatory group was created by the pharmaceutical industry as an attempt to try to avoid complete control by the FDA (Food and Drug Administration)… (They would probably deny that observation, however).

The fact of the matter is, the reason pharmaceutical companies exist in the first place is capitalism, (which translates ultimately into profits made for the shareholders). This industry is unique because the “products” they produce effect real people in a very personal, crucial, and sometimes “life or death” way. This makes them extremely vulnerable to regulation, and public criticism and scrutiny. It also causes dissonance, and conflicts of interest between the industry, the consumers that use their products, and their shareholders. And, of course, there is a strong, hungry, greedy segment of the legal industry that is just salivating at the chance to sue them for some drug that proves to have a negative outcome because of unforeseen adverse side effects, (or, god forbid, deception through hiding adverse data in studies of bad or life-threatening findings.)

However, I am still NOT against capitalism, and that includes the pharmaceutical industry. One of the great freedoms we have living in America is that anybody can go from complete poverty to billionaire, and the only thing stopping any of us is our own drives and talents (in a perfect world we could also add “integrity” to drives and talent) .

I want to challenge anyone to tell me who else would bother to spend millions and millions of dollars trying to develop new medications that might end up proving through complex research and studies to be a wash, or, could possibly help people function and contribute to society, find cures for disease and illnesses, and even give someone more years to live than they would have had otherwise. The answer to that question is NO ONE I can think of. So without them, even with all the good and bad, they play an extremely important role in our lives because they research and study new and novel ways to, yes, make a profit, but also to literally save lives, and make life bearable/and or functional for those that often desperately need help.

As an aside, they also have many patient assistance programs that they should be recognized for. Most of them will supply free medications to patients in low income categories. A good source to find out if you are eligible for these programs is: http://www.needymeds.org/. This industry is in no way perfect, but they do not deserve to be “thrown under the bus completely” in my opinion.

My hope is that we can all put biases and blame aside and just at least listen to each other’s opinions and experiences. I certainly don’t have all the answers, but I do have insights into my own unique world that I hope you can at least consider. I want to always be open to new knowledge that will allow me to have a “shift of paradigm” if another point of view can sway my stigmas and biases. I think the rigidity and prejudices that continually cause us all pain and injustice need to be challenged. I don’t think any of us have all the answers to everything (to think otherwise is delusion and/or arrogance), and my personal goal is to grow and learn and be open to new ideas…and I hope that is your goal.

All of my blogs are dedicated to Jeff, Melissa, and Wayne, and ….Madison and Brooklyn, and of course Unkie, Kirsten and Will!

I love you all dearly!

Penny

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Best Medications Revisited

In December 2006 I participated in a survey of psychiatrists by a pharmaceutical company.  They asked me if I could have only five medications to prescribe which ones would I choose?  Since I have a cash only practice I have to go with the most effective medications long term.

Most medication studies are to meet FDA requirements, which means short studies (6-8 weeks), and they only have to show 50% improvement in symptoms and be statistically better than placebo (that may be associated with only 30-40% improvement).  These studies do not represent real world treatment – patients can’t be given any counseling and can only be on one medication. 

It is only through extensive clinical experience that we can learn which medications are best.

I think of the best medications as the ones that patients come back and say are great….that they have changed their life – side effects are minimal, and the highest standard is that they are still saying it after 6 months, 1 year, 5 years, etc.  If the medication starts working on day one that is a bonus. 

Great medications help you feel better, function better, be less stressed and help protect your overall health.  Great medications also enable you to focus on your life – career, relationships, hobbies, and not be constantly preoccupied by symptoms and survival.  You think – I wish I had this medication a long time ago. 

The main problem with the best meds is cost – especially if you don’t have good insurance – but usually there’s a way to get the medications you need or at least to find generics that are close to the best branded meds.

In my experience stimulants as a group have the highest batting average (the highest percent of the time a particular med works great).  I have patients that have taken them for over three decades.  I haven’t seen any long term problems from taking them.

I was initially trained in the 60’s.  One of the most helpful things I was taught – “if what you are doing isn’t working, do something else.  Even if it is wrong it will get you unstuck.”  This led me to trial and error and eventually to appreciate the value and relative safety of stimulants.

Amphetamines have been available for over 70 years and methylphenidate over 50 years so we have more experience with them than any other medication that we currently use in psychiatry.  Ironically, stimulants aren’t included in the top 10 most often prescribed meds by psychiatrists in the first quarter of 2008.  Despite the fact we have much safer delivery systems the FDA still regulates all the stimulants at a higher level – requiring a written prescription and maintaining a record of each prescription. This creates practical problems, inconvenience, etc.,  not to mention a certain intimidation is felt by doctors.  By contrast, the most abused prescription medications – pain meds – such as Hydrocodone – are much less regulated.

My top 5 list has changed some since 12/06 and hopefully will keep changing as we get even better medications.  For now it consists of the following:

#1     Stimulants – Vyvanse (preferred by 3/4’s of my patients who prefer amphetamines) and Adderall XR (preferred by 1/4 of my patients who prefer amphetamines).  15% of patients prefer one of the methylphenidates such as Concerta, Focalin XR, or Daytrana.

#2     Benzodiazepines – Alprazolam (Xanax and Niravam are my first choice).  Clonazepam, especially Klonopin wafers are a  close second.  

Alprazolam, in a recent study was the #1 med prescribed for stress symptoms by primary care physicians.  Psychiatrists in 2008 used Clonazepam #1, then Seroquel #2, and Alprazolam #3 for stress symptoms.   

#3     Sleeping medication – Ambien CR/Lunesta (I rated Ambien CR first in 06 only because 15-20% of patients have a bad taste the next day from Lunesta – but using a mouthwash with whitener morning and night usually prevents significant taste problems).  Both of these meds work great for most people.  They are both approved for long term use and provide normal sleep.  Short acting Ambien is still preferred by some patients and some take it because it is in generic and they can’t afford CR or Lunesta.  Short acting may not keep you asleep more than 5 hours and has some risk of side effect issues.

No sleep medications were in the top 10 meds prescribed by doctors in 2008.

#4     Antidepressants – Pristiq/Effexor XR – I don’t have enough experience with Pristiq (son of Effexor) to be confident that the majority of patients will end up preferring it to Effexor XR, but in theory it’s better, safer to use, easier to dose, easier to combine with other meds, especially Wellbutrin.  Wellbutrin is the only antidepressant that almost never has weight gain or sexual side effect issues (except for infrequent uses of MAOI’s like Emsam patch).  But Wellbutrin doesn’t have efficacy for the whole range of anxiety and depression symptoms so it would not be the preferred med if you could only use one antidepressant.

Cymbalta is the other antidepressant in this category.  It has more FDA approved uses including fibromyalgia, and generalized anxiety disorder and is very similar to Pristiq in its ratio of effect on serotonin and norepinephrine.  I rank Pristiq first because it has much lower protein binding and therefore gets into the brain faster and works faster.  Prestiq has essentially no drug drug interactions whereas Cymbalta inhibits metabolism of certain medications that can either result in unexpected side-effects or interfere with the activation of pain medications like codeine or hydrocodone. 

#5     Mood stabilizers – Abilify/Seroquel.  There is no perfect choice in this category.  I use these two the most but I also use a lot of Lamictal, Zyprexa (Symbyax) and Lithium.

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