Welcome to the final post in this series on genetic testing to guide ADHD medications. My husband, Dr. Goat, and I greatly appreciate your enthusiastic response.
We based this series on testing that is is no longer available. But the currently existing tests are very similar. The explanations still apply.
The overriding message is this: Be careful about physicians misinterpreting these genetic testing results. Your or your child’s appropriate treatment relies upon being a smart consumer.
Moreover, you needn’t be interested in this testing at all to learn a great deal from this series!
Highlighting My Test Results, By Dr. Goat
As I wrote in a previous post:
There I was, confronted with these unsavory results. After years of pontificating professionally, in the abstract, regarding how pharmacogenetics data should be used, I was now faced with getting off my academic high horse and acting on my own “data.”
Acting on this data proved challenging for one reason in particular: Contrary to the intent of this test—which is primarily intended to guide first-time users of a medication—I had already tried several of those medications over the years, finally coalescing on a “combo” that is probably close to optimal for me.
And guess what? Turns out that my combo disagrees fairly strongly from the test’s recommendations. Does that mean that the test is wrong? Not at all.
First Point: Strattera (atomoxetine)
I am indeed taking Strattera, the sole drug recommended under the “Try these first” category. But I’m taking it at a much lower-than-average dose.
As for the drugs in the “Try these last,” column, the test may well be right indicating that they are not optimal for me. But … I was already taking one of these. In short, I have no way to tell without experimenting, and that’s something I don’t want to do unless I have strong reasons to do so. Experimentations can be very disruptive personally and professionally, so I am reluctant to mess around with what seems to be working. Let’s just say I experience profound benefit from Concerta. The idea of stopping it based on misinterpretations of this test? Insane.
Gina would like to pipe in for a second:
Note that the third (try these last) column includes the first-line treatments for ADHD: the stimulants! It also includes some down-the-line medications sometimes used for ADHD but often with stimulants.
This is an excellent example of how the testing in no way takes into account which medications are most likely to be effective for the condition being treated.
The list of disclaimers includes:
- The prescribing physician should review the prescribing information for the drugs being considered and make treatment decisions based on the patient’s individual needs and the characteristics of the drug prescribed.
- This test looks only at the patient’s genotype and its relationship to these drugs.
Second Point: Wellbutrin (bupropion)
Second, I was prescribed Wellbutrin early on (listed in the second column), but only after I had started taking a stimulant. Plus, my physician at the time prescribed 300 mg right off the bat. The result had me flat on my back on the sofa, for two days—a prime example of the importance of slowly increasing dosage.
That was the last time I didn’t “start low, titrate slow,” no matter what the prescribing doc said. Gina had had quite enough of physician recklessness by that episode, and she stood firm. It took me a while to join Gina in questioning my MDs. It was hard to accept that having a medical degree—and, further, being a board-certified psychiatrist—did not necessarily mean that the prescriber would be all that, well, smart. Or even careful.
Guidance Notes
Here are the guidance notes for this particular “menu”:
1 Patients with this genotype are less likely to respond to alpha-2 adrenergic receptor agonists [e.g. clonidine, risperidone]
2 Patients with this genotype are less likely to respond to the amphetamines. Consider using medications from another class to achieve desired therapeutic outcomes.
3 Patients with this genotype at ADRA2A are less likely to respond to methylphenidate. Patients with this COMT genotype are less likely to respond to methylphenidate.
4 Use with monitoring. Patients with this genotype may benefit from higher total daily dose (TDD) of bupropion, ranging from 320mg-420mg/day if suboptimal response at lower dosing.
5 Extensive metabolizers may show appropriate response to atomoxetine at the higher end of the recommended dose range.
Taking The Results One By One
Let’s review the printed information on the first gene, and I’ll follow with a translation. (To see a larger version, click the image below.)
Dr. Goat’s ADRA2A Gene
Genotype: CC
Prevalence: 48% of patients
Phenotype: Reduced Response (CC): This genotype is associated with the reduced response phenotype. This patient is homozygous for the C allele of the 1291G>C polymorphism in the adrenergic alpha-2A receptor gene, which decreases binding affinity at the alpha-2A receptors. Patients with this phenotype may show a reduced response to methylphenidate and the alpha-2 adrenergic receptor agonists.
Translation: Aargh, this means I’m walking around with a semi-crappy ADRA2A genotype.
Remember post 4? The topic was pharmacodynamics (ADHD Medications Pharmacokinetics & Pharmacodynamics) This genotype means the functionality of the protein produced by the ADRA2A gene, namely, the adrenergic alpha-2A receptor, is a bit wonky.
As such, it reduces the effectiveness of this receptor’s interactions with a number of stimulant drugs as well as the alpha-2 adrenergic receptor agonists (e.g. clonidine and guanfacine).
The Big Gulp and the Sausage Maker
In other words, and in keeping with the analogy I used in that post, the “Big Gulp” of these medications is only loosely fitting in my cup holder (receptors), such that I might want to consider a higher dosage of the drug. And remember: this is only as far as this particular gene is concerned (there are many other factors beyond this one gene!)
I would also have to take into account any other drug I might be taking. Why? Because all drugs are metabolized to be ultimately removed from the body.
Think of the sausage-maker stuffing meat the sausage machine. It’s possible to over-feed that machine, at which point bad things can happen. That’s why your physician and pharmacist should always be consulted before making such changes.
My semi-crappy receptor is not completely trivial. But obvious strategies exist for dealing with it (e.g. higher dosage).
As I said before, we all have semi-crappy genes. I sure Gina has some unsavory genetic variants in her genome … somewhere.
Dr. Goat’s CYP2D6 Gene
Genotype: *1/*1; CNV=2
Prevalence: 77% – 92% of patients
Phenotype: EM: This genotype is associated with the extensive metabolizer phenotype. When considering half-life and area under the curve (AUC) of atomoxetine in CYP2D6 extensive metabolizers, patients with this phenotype are likely to respond to atomoxetine, but may require doses at the higher end of the recommended range.
Translation:
Yeah! A decent genotype for once! This is the most common form of this gene (that’s what the “*1/*1” means), such that the protein is very effective at metabolizing drugs (“extensive metabolizers” – see previous post).
As with Gina, I might benefit from increasing the dosage of atomoxetine (Strattera) somewhat. So I guess this fits with my benefiting from Strattera, which appears to be the case.
Just for fun, let’s look at one more of my genes:
Dr. Goat’s CYP2B6 Gene
Genotype: *1/*6
Prevalence: 48% African Americans, 25% Asians, 38% of Caucasians
Phenotype: IM: This genotype is associated with the intermediate metabolizer phenotype. Based on ability to metabolize bupropion to hydroxybupropion (HB), patients with this phenotype, who show a 20% decrease in HB levels, are likely to benefit from a higher total daily dose of bupropion.
Translation:
Boo, another semi-crappy genotype. Oh well.
The interesting thing is that bupropion (Wellbutrin) might be a useful medication for me after all. As I previously mentioned, I did try it years ago, but only after I was already taking a stimulant—and starting at too high a dose. Perhaps that’s why it wasn’t beneficial at the time. In other words, this medication never got a fair shake. It’s useful to know that I might benefit from this drug.
Remember: Only One Piece of the Puzzle
There you have it, folks! In these 7 posts, you have everything you need to know about interpreting gene tests to inform ADHD medication choices.
Does genetic testing for ADHD Medication provide vital information? Maybe, if you have some unusual mutations or you are a very rapid/slow metabolizer. That is useful information. But is this the best way to identify optimal medication? No. Absolutely not.
There are other puzzle pieces, including the huge number of published studies examining the overall efficacy of ADHD’s first-line medications: namely, the stimulants and Strattera.
Overview of This Series
The full list of posts in this series: Genetic Testing for ADHD medications: Overview
For More Guidance on ADHD Medication Choices
There is no “silver bullet” in finding the best medication(s), at the best dose for you. But there is a relatively straightforward “trial and error” method, as described in Gina’s book, “Is It You, Me, or Adult A.D.D.?”
Gina feels strongly about this topic. She believes that everyone with ADHD deserves the opportunity to optimize medication. Unfortunately, she has also seen this is not readily available—including among many psychiatrists claiming ADHD expertise. That’s why she created this soup-to-nuts online course—on ADHD-related sleep issues and medication. Course 2: Physical Strategies
—Dr. Goat and Gina Pera
Any thoughts on ADHD meds that might work for a CYP2D6 Ultra-Rapid Metabolizer? My kiddo has been doing okay on Intuniv and Zoloft, but is older now and really needs something for concentration. Thanks!
Hi Jo,
Why not methylphenidate or amphetamine stimulants? Those are the first-line medications for ADHD.
Not Intuniv and certainly not Zoloft (an SSRI).
Being an ultra-rapid metabolizer on CYP2D6 means only that a larger dose is typically needed. It doesn’t mean not taking a stimulant.
How many MDs ordering these genotype tests understand this? Too few.
cheers
g
Hello! Thank you for this article!
Recently, I was diagnosed with ADHD, and I was prescribed different stimulants that would not do anything except cause some side effects, even at high dosages.
My doctor ordered me a genetic test that indicated that I carry ADRA2A C/C and SLC6A4 S/S (short serotonin transporter). Now I see why I did not react to the stimulants, and I had no “green” ADHD take-as-prescribed medication on the list at all.
What do you think? Is there a way to normalize the work of the brain somehow? Are there any supplements that would be helpful? My doctor is not against taking supplements, but she cannot recommend me anything since there’s little to no research done on the ADRA2A C/C people.
I asked my doctor, and she agreed we must continue looking for the proper medication and dosage. But I am tired.
Thank you,
Agness
Hi Agness,
I can only imagine how tired you are. Sometimes I wish we could fast-forward 50 years or so, and hope for better, clearer ways to select medications.
Here’s the thing, though: When someone tells me they were “prescribed different stimulants”, it really tells me nothing. Because I’d want to know sleep status, diet, generic vs. brand, delivery system, stimulant class, and a lot more.
Things that many prescribers don’t even know to ask about. Which is why some overly rely on these tests — and don’t know how to interpret them!
I cannot possibly have an opinion in your case. I’m just saying, this is the realm of possibility. These are all issues to consider before “going into the weeds” of genetic-testing.
If you read about my husband’s test results, he had only one Rx in the “green” category: Wellbutrin. Does that mean Wellbutrin would address his ADHD symptoms? No, it does not.
I know this series is a lot to take in. But I encourage you to read it start to finish, a bit at a time, taking note of the bits that resonate for you.
It might be that stimulants — the first-line Rx for ADHD — might work well for you with a more informed approach.
I am completing right now Course 2 in my online training, solely on sleep and medication. Stay tuned!
Gina
Hi Gina,
I appreciate you and your husband devoting so much efforts to better understanding and coping with ADHD. I was wondering if you may help me understand whether, in your opinion, you think trying an alternative medication (I am thinking Strattera?) would be beneficial.
I have been taking immediate release generic adderall for nearly 10 years (20mg 3x/day) but no longer feel like it is effective. At first I thought it was due to the pharmacy switching generics on me, (there is a stark difference in generics efficacy when I get Teva vs the other one), but I don’t think its that, more so – my current treatment isn’t working and I am scheduled to see the doctor next week. I had a severe adverse reaction to wellbutrin which prompted a genetic testing (my nearly 8th failure at an antidepressant and/or anxiety med) where like your husband I did not win the genetic lottery!
In terms of ADHD genotypes you mention, my results indicated I am a poor metabolizer of CYP2D6 *4/*5 but extensive normal CYP2B6 *1/*1. While the test is not be all say all, it explained ALOT about why I would get violently ill from codeine, why so many antidepressant treatments failed for severe AEs etc.
That aside, I don’t know what medication to attempt (as there are so many) and hoping you or your husband may provide your two cents on the matter.
Side note: I thought to try Strattera as I found some helpful information on dosing for CYP2D6 poor metabolizers –
https://www.ncbi.nlm.nih.gov/books/NBK315951/
Looking forward to your response, thank you kindly
Alex
Hi Alexandra,
Thank you for the kind words. It was a lot of work. 🙂
Just to be clear: My husband and I worked on this together, to explain pharmacodynamics, etc.. But I’m still the ADHD expert in the house. He’s involved in other scientific pursuits, like cancer. 🙂
There is an expression in the medical diagnosis field: Think horses, not zebras. In other words, instead of jumping to a complicated and rare diagnosis, start with the basics.
The basics in your case might be less in realm of genes, snips, and enzymes and more in…..the basic protocol for treating ADHD.
For example, maybe you’ve tried a methylphenidate stimulant and just didn’t mention it. But anyone starting ADHD medication should be given a trial in each class. Unfortunately, many are given an amphetamine (more often than not, Adderall), and that’s it. Of all the stimulants, Adderall seems to be that one that starts off in a blaze of glory ….. and then peters out over time. Often more quickly than 10 years, though.
I wonder if antidepressants have failed you so many times because it wasn’t depression at all. It was ADHD-related fallout that appeared as depression to the untrained clinical eye. It happens ALL the time. Especially with women.
At least you might have an answer about codeine, though!
I would also wonder:
—Have your habits changed around eating, sleeping, exercising?
—Is it possible that you are entering peri-menopause or menopause?
These issues can affect how well a stimulant works.
Also: Has your life started demanding more of you in the way of Executive Functions? Sometimes Adderall works well for a person, in terms of sort of propelling them through the day. But when life gets more complicated, and they haven’t steadily been developing supportive habits, Adderall taps out.
As for Strattera, it’s worth a trial. The last I heard regarding the research, Strattera tends to work well for about 30% of people with ADHD. That’s much lower than the stimulants. Will you respond well to it? It’s impossible to know until you try. No genetic test can tell you that, unfortunately.
We’ve known for a long time about the CYP2D6 enzyme issue with Strattera/Atomoxetine. Another good reason to follow the “start low, increase slow” rule that applies to all psychiatric medications.
I hope this helps! Good luck!
g
Hi Gina,
I see that Adderall XR is metabolized bu CYP2D6 and that Vyvanse is not metabolized by the P450 system. So, if dextroamphetamine=Adderall XR and Vyvanse breaks lisdexamfetamine into dextroamphetamine, wouldn’t it also need to be broken down by the 2d6 enzyme at that point? I’m confused as to whether the Vyvanse does, in actuality, use that enzyme. Very long story but trying to find a stimulant for my 17-year-old daughter. She is a low partial metabolizer for 2d6 and didn’t do well on the Adderall. I told her doctor I didn’t want that med, but my insurance wouldn’t pay for the Vyvanse and that’s what she got. So I guess I’m asking if you think that she would have the same issues on Vyvanse or would it be worth a shot? She tried Concerta as well up to 36mg and it did nothing. I still think she may have made it a higher dose . I am having very hard time with her doctors . I was very interested to see your series on this topic as many doctors and psychiatrists still are not educated in drug metabolism. Thank you for any help!
Sue
Sue
Hi Sue,
I’m not sure I understand the question. Mainly because you wrote: “dextroamphetamine=Adderall XR”.
Do you mean that the two are the same? Because that’s one thing I can tell you: they’re not.
That means, perhaps she will do better on Vyvanse than Adderall. It just depends on her genetics, not just the metabolizing genes but all the rest. About 40% of people with ADHD do clearly better on one class of stimulants than the other (MPH vs AMP). They should be given trials of each.
Many people do poorly on Adderall, for a host of reasons, and do better on Vyvanse. But some don’t do well on any amphetamine—or any methylphenidate.
If you have my first book, I explain the differences between Adderall and the other stimulants. Adderall was a problem 20 years ago, and it’s still a problem! Because too many prescribers don’t have the first clue about it—but still believe it is the “best” for adults thanks to aggressively persuasive pharma reps of years ago. It’s a deplorable situation.
https://amzn.to/37ea04V
She tried brand/authorized-generic Concerta? Because the Concerta generics don’t work as Concerta goes. Poor approximations (though they might work well for people who well on actual Concerta).
Did she go up to 54 mg? Might have made a difference.
You also want to have a clear idea of what “working” will mean. Treatment targets. Also, try to address any sleep deficits before starting the stimulant. It can affect response.
I hope this helps.
Gina
I have tried in total 4 types of adhd medications. First, I tried Ritalin modified release but had too much anxiety in general to get to a decent dosage. Then I tried Strattera. Had to stop due to high diastolic blood pressure and little effect. Then I was put on Concerta a year later with 72 mg having no effect except depression and high pulse rate. I am now on Vyvanse, just started taking the max dose (70mg) after 1 month. Still not a good effect, but at least less depressing. I have tried potentiating with antacids without luck. I also respond very little to codeine, and my tolerance goes through the roof after 3 days. This is a recent development. I used to get very CNS depressing effects of codeine when I started using it for severe menstrual pain years ago.
What does this mean? Rapid metabolism? I haven´t tried any immediate release, just XR.
Hi Birgitte,
Sorry you’re having such trouble. Yes, it’s possible that you are a rapid metabolizer, but you’d need tests to confirm that. And if you’re at 72 mg Vyvanse with “not a good effect but at least less depressing,” I’m not sure that would be useful. Especially if it’s not covered by insurance and money is tight.
Assuming the diagnosis is correct, there could be many other reasons why Ritalin, Strattera, and Concerta did not work for you:
e.g.
—Generics
—Sleep deficits
—Caffeine/nicotine consumption
—Nutritional deficiencies
—co-existing anxiety (that is, not as fallout from ADHD but as a genetically co-existing condition; many adults with ADHD do best on two Rx)
You say you are getting someone more of an effect from Vyvanse. Maybe that means you respond better to the amphetamine class of stimulants.
Adderall is not my favorite Rx; it gets many people into trouble — and most prescribers haven’t a clue.
But it might be that it’s extra mechanism of action is what works for you. Might be worth a try.
I hope this helps.
g
Since Vyvanse, Risperdal, and Adderall are all metabolized by CYP2D6, would this seem like a reasonable drug regimen for a patient who is a CYP2D6 poor metabolizer? These are the results I received, and doctor is not willing to discuss.
Hi N,
First, regardless of CYP2D6 metabolizer status, you want to know that those three medications are necessary and represent methodical treatment — not just throwing spaghetti at the wall.
Maybe that’s the best approach for you. To me, I’d be wondering if the Risperdal was added to address the side effects from perhaps-not-the-best stimulant choices.
Also: Adderall is not the same stimulant as Vyvanse. Vyvanse contains dexedrine. Adderall contains mixed amphetamine salts.
But I’m confused. You’re saying that the genetic testing indicated that Vyvanse, Risperdal, and Adderall are the choices for you? And that this prescriber ordered the testing? Or you did it independently?
Personally, I’d be wary of any prescriber who is “not willing to discuss”. That is, not explain the reasoning.
Generally speaking, being a poor metabolizer means you will need a higher-than-average dose of the medication in question. It does NOT mean that you should not take the medication.
I hope this helps.
g
I need a list of meds for people who are poor/non metabolizers for CYP2D6. I get that dosing varies outcomes but I’m desperate for my son to get meds without continued damage to his liver and these doctors have no idea what I’m talking about when I ask them the pharmacokinetics of what is being prescribed.
Hi Chris,
Do you know for a fact that your son has liver damage? A liver panel was performed?
What kind of list of meds do you mean? For ADHD specifically?
Generally speaking, it’s Atomoxetine (Strattera) that comes to mind with CYP2D6.
Cleveland Clinics is typically not the best resource for ADHD but this article happens to be useful regarding Atomoxetine specifically.
https://consultqd.clevelandclinic.org/the-pharmacogenomics-of-adhd-treatment/
Other than that, it will have to be on a case by case basis. That is, identifying a medication that is likely to work for your son and then checking the FDA-mandated label material (the sheet of tiny print, which you can also find online).
For example, this label for Adderall refereences CYP2D6:
https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/011522s043lbl.pdf
I hope this helps.
g
Gina,
I am so disappointed to learn that Genesight doesn’t test for response to the ADHD medications. Do you know of any other companies right now that do???
Hi Laura,
Why are you disappointed? What were you hoping to learn?
There is really not much benefit — and if not read correctly, results can lead treatment astray.
That’s why we wrote a 7-part series. To warn about this.
I think Genesight actually does offer the test. You should check directly with the company.
g
Thank you for covering this info. As I’m sure you know, Harmonyx is not currently active. My child was genetically tested as a rapid metabolizer CYP2C19.
He also has ADHD.
Do you have any info on what his try first / next / last meds would have been?
His dr was willing to apply this information but admitted to being ignorant about what to do with it. Thank you.
Hi Melanie,
Yes, unfortunately Harmonyx is no longer administering this test. For various reasons.
The three columns of first/next/last medications were a problem from the beginning. After hearing reports from parents, misinformed by the notion that they could not give their child medications in the first column, I tried to educate the public on what this testing truly meant. And it wasn’t that.
The main benefit of this testing, for most people with ADHD, is to identify whether one is a rapid or slow metabolizer. Now that you know your son is a rapid metabolizer, that means that he might need higher-than average dosages in order to have the necessary effect.
Otherwise, your son’s prescribing physician should be following a standard protocol for treating ADHD plus any co-existing conditions.
I hope this helps.
Gina
Is there a site that gives all the types of codes for ADHD? I had some done but can’t read what the results mean. I understood the C/C example because I am the same. My therapy office is trying to use this to say that you are or are not ADHD. Any suggestions would be helpful. Maybe a chart of some kind.
Hi Alyson,
I’m not sure what you mean — “all the types of codes for ADHD.”
Do you mean genetic markers? If so, there are none.
These genetic tests examine factors that affect medication.
I’m not sure what your therapy office is aiming for, but there is NO genetic test for ADHD.
best,
g
Ι constantly spent my half an hour to read this web site’s articles
or reviews aⅼl the time along with a cup of coffee.
Pingback: ADHD, DNA, and Predicting Medication Response: Part 1 - ADHD Roller Coaster with Gina Pera
Gina,
Thank you and your husband for providing this much needed venue for those with and impacted by ADHD. I appreciate the scientific detailed and current information presented in a professional manner. Keep up the great work! Lyn
Thank you so much for posting this! My 8 year old is adhd and trying to navigate all the info out there is overwhelming. I think we will have to really consider trying this for our son.
Hi J.
Yes, it can be overwhelming. But it needn’t be.
Step by step.
Good luck,
g
It would be nice to know whether the gene testing is available in Canada. (It would also be nice to know if “Margaret”s are statistically overrepresented in this responder list. I wonder if it might also indicate an age group? 😉 )
The experimental phase of finding the right drug is exasperating – it takes an expert advisor, it takes time, it takes a close observer to verify and sometimes notice results – all at a time when life continues at the speed of light! My 22 year old will have none of this medication stuff – we never did find what worked for him. His brother, at 17, has just been diagnosed, and after a catastrophic Concerta-induced breakdown in school, is also heavily resistant. He is virtually paralysed by stress when it comes to school work and exams. He needs some help NOW. The other lad hasn’t face the same ‘failure to launch’ issues – he’s launched in so many directions over the past 4 years that you can spot our house on the horizon because of the fireworks! My own diagnosis didn’t come until after menopause decimated my already inadequate coping skills. Continuous chaos is not a comfortable way to live. It would be huge if this testing could shorten the route to help.
I have to say I really appreciate that you take the time, and provide readers with the courtesy of respect, to provide the scientific details with no apology. There is so much pseudoscience out there, that I really appreciate being able to get at the results from the beginning, instead of hearing summaries of summaries of summaries.
Hi Margaret,
Summaries of summaries of summaries! Perfect! That’s how I felt about book’s descriptions of ADHD medications. A summary ending with “talk to your doctor.” But what if the doctor knows diddly?
That’s why I included several chapters in my book.
And thank you for noticing that I like to treat my readers with respect. It was a gamble, getting this “geeky.” But I figured at least a few people would appreciate it. Instead, it’s been extremely popular (though you wouldn’t know it by the paucity of comments on the rest of the posts).
I have asked my contact at Harmonyx about Canada. Will report when I learn.
tx
g
I am learning so much from this. Thank you once again for all your hard work. Your opening so many doors for people like myself.
Now on to my situation. I have already told you that I’m talking Concerta 36mg 2 X daily.
The thing is it does work, however years before I was diagnosed with ADD I was on medication for weight loss and that medication was the perfect fit for my ADD. It was however a drug that was taken off the market due to abuse years ago by people who didn’t need the drug. As for myself it worked wonders for me. Far better then the Concerta I am now taking. The problem is with so many people abusing drugs these days It’s hard to walk into a doctors office and say I want to take stimulants because they worked so well in the past. And I realize Concerta is a stimulant. The Concerta does work but not nearly as good as the drug I took years ago. For that reason I would really love to get this testing done. Seems like the whole world is more concerned with the drug abuser’s then the people who truly benefit from this type of medication, myself being one of them. The Concerta is not without side effects and as I said it does work but the feeling of well being isn’t the same as it was on other medications. I have settled for the drug I am now taking because without it I would be unable to stay awake, or drive a car, or hold down my part time job that requires a lot of paper work. My life is at least livable taking Concerta but how I long for the right drug to help me live the productive life style of my past. It’s really hard knowing how much better I can feel on the right drug but still be stuck on a drug because no one really knows which drug is the right drug to prescribe. ( Sorry for all that double talk) LOl
Hi Margaret,
Thanks for your comment.
I’m wondering if you ever tried Vyvanse, Adderall, or Dexedrine. It might be that you are one of the people who responds better to the AMP class (Amphetamine) than the MPH (methylphenidate) class.
MPH – Ritalin, Concerta, Daytrana, etc.
AMP – Vyvanse, Adderall, Dexedrine.
I can imagine how frustrating that must be, remembering how much better another Rx worked for you. It might be like remembering how skinny and agile I used to be. lol!
Maybe you could research it and see what was the active ingredient in that drug. (Are you talking about FenPhen?)
Thanks for your comment,
g
Knowing which medication doesn’t work well because of a genetic variant will help a lot. I appreciate Dr. Goats experience with medications and thank you both for taking the time to inform us on this complex subject. I am 67 with ADHD, taking stimulant medications with an unpleasant experience with Strattera in my past, and would be open to augmenting my meds to make my wife’s life easier. Everytime I think I have moved toward normal in some way it isn’t long before I am reminded or realize my improvement is a cut off a cartload compared to the work remaining.
Scott
Hi Scott,
A “cut off a cartload.” That’s a new one! I like it. Very alliterative. 😉
I bet the Strattera was at a high dose? My husband takes 40 mg. He cut back to 25 mg one time, and let’s just say, neither of us enjoyed that interlude. 🙂
Most people (including MDs) would be skeptical that a mere 15 mg could make such a difference. But trust me…
Hardly any person with ADHD that I’ve encountered does well on a stimulant alone. There almost always needs to be a balancing act with the other neurotransmitters. So, a stimulant with low-dose Concerta or an antidepressant….that’s pretty typical. But there are a ton of exceptions.
Good luck with that cart!
g
Thanks so much for this series. We reside in a rural area in No. CA and have been unable to locate where/how we can access a Harmonyx testing kit. Can you please provide more info on this? Thanks
Hi Denise,
Harmonyx says the kit will be available on the West Coast soon, through Rite-Aid stores. Maybe one is near you?
If not, there are tests that your MD can order, such as through Genesite. Sometimes insurance pays for part of it.
Another option would be trying http://www.23andme.com But you get only the raw data, which must be converted into an accessible form. Some websites are starting to do that. So, this would be an option for these ADHD meds only if you pick out the various gene variants from the 23andMe data. Not for everyone.
best,
g
Hi,
Just wanted to add something to Gina’s suggestion re 23andme.
We’ve done that testing, and while it’s very helpful on many fronts, it tests for selected snps but not copy number variants. So, if we had not also done targeted P450 genetic testing through our doc, we wouldn’t have learned that she was in the tiny percentage of caucasians who are cyp2d6 ultra-rapid metabolizers – thus making some medications/doses potentially too weak (e.g., strattera) and others too potent (e.g., codeine).
Harmonyx I believe, as well as tests a doc would order, will look at pertinent polymorphisms and copy number variants.
Oh, thanks, Lattegirl! Very important info!!
g
Thanks for the series! My hubby has been experimenting for 10 years now, but is interested in what the DNA might suggest. Very interesting series.
This series had such great information! I didn’t even know this type of test even existed!
wow how interesting. Is there anyway to do this in Australia?
Hi Tracy,
I wish I knew about gene-testing in Australia. But I did find this article from last fall.
http://www.news.com.au/lifestyle/health/gene-test-that-maps-your-hidden-health-problems-available-in-australia-for-under-2000/story-fneuz9ev-1227116148443
best,
g
Very informative series of articles. We have been considering this but didn’t know of anyone who actually had the testing done
Thanks Gina for a great series…my husband Steve is anxious to take the test, but we found the closest pharmacist who offers it in the San Francisco Bay Area is located in Patterson (central valley). Steve talked to our local Walgreens pharmacy, but as mentioned in a post above, they cannot offer it unless it comes down from corporate. Any chance you could advocate at the high levels of CVS or Walgreens to get them to offer this testing in communities that are requesting it? I’m sure we could get a fair number of folks from you ADHD support group here in the Bay Area to take advantage of it.
Thanks again for all you do for this community.
Margaret
Hi Margaret,
I learned this yesterday from Harmonyx. They are partnered with Rite Aid and the roll-out on the west coast will be implemented in the next few weeks.
g
I read all parts of the series. While some of it was a little technical, I found it very informative. It’s exciting that they have this testing and hopefully it’ll help when trying to figure out where to start.
My husband and I are both ADHD, not realizing it until adulthood after getting our kids tested. And guess what, both kids are ADHD as well! One is hyperactive and the other, inattentive. I feel as though we have a decent combo for the inattentive child, but we can’t nail down a medication combo for our hyperactive child. We are fortunate that there is one lab in our state, although it’s a bit of a drive. I’ve been going back and forth as to whether or not to get said child tested, as it seems that the testing is more of a guide, than an answer. But, I guess it’d be interesting to see what the results are!
Thanks again for the thorough and thoughtful post.
Thank you for the interesting series of articles. I am considering getting genetic testing for my son who has ADHD, prior to starting him on any medication. I think it may give his doctor a better idea of what medication to try first, rather than guessing.
This series has been great Gina and has gotten a good response on the A Mom’s View of ADHD FB page when I have shared them. I think riding the medication roller coaster is one of the most frustrating parts of parenting a child with ADHD. We have had really awful experiences with medications for my son. Nobody likes feeling as though your child is a “guinea pig” when you begin trialing medications. Being able to use genetic testing like Harmonyx takes some of the fear and dread and frustration out of the experience. I would love to be able to test my Ninja Boy! I tried to access Harmonyx months ago when it was first made available but no local pharmacy is offering it. I have talked with the pharmacists at the place where I get prescriptions filled and they are interested in offering it but are part of a corporation (grocery store) so of course have to wait for corporate to get on board. I hope many families can begin to take advantage of this opportunity, especially because it is relatively affordable. Thanks again to you and Dr. Goat for this very informative series!
Hey there I am so grateful I found your website, I really found you by error, while I was searching on Aol for something else, Regardless I am here now and would just like to say many thanks for a remarkable post and a all round thrilling blog (I also love the theme/design), I don’t have time to go through it all at the minute but I have saved it and also included your RSS feeds, so when I have time I will be back to read a great deal more, Please do keep up the excellent job.
Thank you so much for doing this series – this kind of testing would have been exceedingly helpful to my ADD daughter’s journey!
I’m also wondering if you know what the next mental health condition/medication areas will be for Harmonyx to pursue, and whether they might also look at some of the well-understood herbals in the future?
I can’t wait for your future forays into genetic testing and interpretation!
WOW! is all I can say. I’ve been teaching for 16 years and have seen ADHD meds in the classroom setting for a while. Then I had my own two beautiful littles and come to find out my husband and I breed ADHD! He was diagnosed shortly after my 2nd child was born and has struggled to find the right med. Both children are on some type of med, but their ADHD manifests itself differently in each. Me being the only non-diagnosed person in the family is continually trying to make sure that my children are on the right meds, and trying not to nag my husband when I know in my heart that he isn’t on the right medication! The first person in the family to get the testing will be my husband! These posts have been very interesting and informative! Thank you so much for the research and the writing the article in a way that a regular old joe can understand!
Thanks for one’s marvelous posting! I seriously enjoyed reading it, you may be a great author.I will be sure to bookmark your blog and may come back down the road. I want to encourage one to continue your great writing, have a nice holiday weekend!
Fascinating. It does seem like this test could help lessen at least some of the trial and error involved in finding the right medication and the right dosage. I really learned something new here. Thanks!
I loved the mental image I got of Dr. Goat riding his High Horse.
Haha, Angee!
My son Matt is 22 years young and he’s been inundated with ADHD for several years. He’s tried Concerta and Adderall, plus his doctor even gave him Paroxetine, a generic for Paxil; however, not to much success. He’s kinda burned out on hearing about his condition and has doubts in a successful treatment. I think he would jump at the chance to try the Harmonyx Diagnostic test to know what might be a solution in understanding his make-up and his choices. Thanks for your help with this issue.
P.S. I loved this series keep up the great work!
Denise Mueller
Now this stuff gets me excited. I love science for trying to make sense of the seemingly unfathomable.
Genetic study has always fascinated me, and now that I’m the adoptive mum of a young boy with ADHD my interest in genetics has been fuelled again. I would be thrilled to find out my boy’s genotype, to help in future decision making when it comes to his meds. We are presently involved in the “trial and error” stage, working out amounts and types of meds. It would be a lot easier with some sort of “guide”, such as harmonyx. I’m very interested in this work!!!
I just recently stumbled upon your blogs, and have been glued to my email for the latest posts!
Thanks for the insight,
Sheila
until your blog post I had no idea this was available for ADHD. Thank you so much for this valuable information. My husband is really struggling with his adhd symptoms right now and could really benefit from this testing
Thanks for your posts! I did not even realize such tests existed. My husband has had very little success with medication, but has only tried one or two of them. Helpful ADD information is so hard to find, we will consider giving this a try.
Wow. That is so complicated. No wonder it’s so hard to find medications that work well and explains why a migraine medicine prescribed for a friend, won’t do a thing for me.
And doctor’s really like that one size fits all idea, don’t they?
Thanks for explaining all that to us. I really didn’t understand it at all when you posted it to the group.