Hi,
Read the following and it may explain why there is weight gain associated with
Lexapro. Why when tapering the lexapro you can get sweats, muscle tightness, and stomach cramping.
DNA
While rereading the description of an antidepressant in the Physiciansâ Desk Reference in the year 2000, one sentence stood out and almost seemed out of place with the other text in the same paragraph. This was the mention of the term P450. P450 is the name of a group or set of enzymes in the liver used to metabolize most prescription medications, herbs, some foods and some liquid drinks.
More research. I found there existed a way to tell what an individuals enzymes were like with a simple DNA test, requiring only a blood draw. Using this test, you could predict to some degree medication or drug adverse reactions. This was useful information, indeed, if one was attempting to get others off drugs.
DNA Drug Reaction Test of the P450 â CYP enzymes provided additional information but as time passed it became clear one could not fully rely on the CPY enzymes to predict drug adverse reactions. With DNA testing being a relatively new science it was not surprising to find new genes, other than the P450, were directly related to an individuals ability to metabolize psychoactive drugs.
HOW MEDICATIONS METABOLIZE OR MOVE THROUGH THE BODY
Our individual DNA plays a significant role in how medications metabolize.
This much became very clear, utilizing available DNA test.
Our body has several liver enzymes that play a direct role in metabolizing not only medications, but also foods and liquids. Our individual DNA determines how much quantity of each enzyme we have available.
Antidepressants, ADHD medications and anti-psychotics use a group of liver enzymes called the CYP2D6, CYP1A2, CYP2C9, and CYP2C19. Most antidepressants, ADHD medications and anti-psychotics use the CYP2D6 pathway only. A few antidepressants will use the CYP2D6 as well as other CYP enzymes to metabolize.
The pie chart to the left shows the percentage of the P450 enzymes. The CYP2D6 used by most antidepressants, ant-psychotics and ADHD medication is in red.
Each of us has our own unique DNA pattern. Not all of us have the same size slice of this pie. 12% of us will not have as much enzyme in the red slice while 34% of us will have too much or more than normal. This means that just under 50% of the population does not have a ânormalâ amount of the CYP2D6.
Hereâs a way to visualize this problem:
Get yourself a tablespoon of water and a 1â section of toilet paper. Place the toilet paper on a flat surface and then begin to slowly pour the water from the spoon onto the toilet paper. In the beginning, the toilet paper is able to absorb the water, but as more water is poured on the toilet paper, it becomes saturated, unable to absorb additional liquid.
If the water were medication and the toilet paper your body, the amount of water the toilet paper could not absorb would remain in your body for an extended period of time and undoubtedly cause side effects. The body, unable to use or excrete this extra medication, will store itâ¦and even use it later, as fat cells release their stored contents. The drug would simply accumulate in your body, building to ever-higher levels of saturation.
Example: If you are taking the ADHD medication
Strattera, and you are a poor metabolizer of the CYP2D6, the Strattera would remain in your body 10 times longer than normal and the peak concentration of the Strattera would be 5 times greater.
Letâs go back to that toilet paper:
Imagine if you had one tablespoon of water and one tablespoon of tea and you began to pour both liquids on the 1" piece of toilet paper? This would be the same as taking more than one medication that uses the same enzyme for metabolism.
Several supplements, foods and liquids will also open the flow and produce an abundance of the enzyme, and compete for the right to be metabolized. Example includes coffee and cigarettes. Coffee will block a medication from metabolizing. Cigarettes will open the flow.
The usefulness of the DNA data with The Road Back Program is twofold;
1) to use as a guide when looking at nutritionals to ensure the least chance possible of a drug/nutritional interaction, and
2) to offer advice on which medications will greatly alter the clearance time of other medications.
Titrating Psychoactive Medication:
The FDA first published a method of medication reduction in December 2001 for
Paxil withdrawal. The only difference between the published FDA reduction schedule and The Road Back schedule from 1999 is: The FDA and GlaxoSmithKline (the company which makes and sells Paxil) recommended that when you dropped down to 20% of the original dosage, you should just discontinue from that level.
For some people, not to put it too directly, thatâs tantamount to suicide.
The Road Back feels the last dosage reduction of 20% is significantly too large. 10% is our recommendation as the reduction schedule throughout (except with a Benzodiazepine, which should be tapered even slower.) A persons DNA is unique, and can alone determine the success of a drastic dosage reduction. It can also determine its failure, and the cost of such a failure can (and has often been) catastrophic, and occasionally fatal.
In the early days of psychoactive drugs psychiatry did not titrate psychoactive drugs up slowly on patients and the results were catastrophic for the patients.
Many drugs, other that psychoactive drugs must be titrated up as well as down before discontinuing.
There seems to be a general consensus within the medical community psychoactive drugs can be reduced quickly or patients can be taken abruptly off one psychoactive drug and prescribed another psychoactive drug without an adverse consequence to the patient. This is not the case.
Even switching a patient from a tablet form of a psychoactive drug to the liquid form of the same psychoactive drug will cause the patient to experience extreme adverse drug reactions.
THE HYPOTHALAMIC PITUITARY-ADRENAL AXIS (HPA AXIS)
The Hypothalamus is a part of the brain, which links the nervous system to the endocrine system via the pituitary gland. The Pituitary gland is located below the hypothalamus and the Adrenal gland is located atop the kidneys. The pituitary gland releases several hormones (chemicals produced by a gland) that in turn control other glands and various actions within the body. The other glands regulate growth and hormones.
When the HPA Axis is out of balance, you will have a problem with
insulin, stress, anxiety, weight gain,
thyroid problems, fatigue, unbalanced sexual hormones, and countless other body difficulties.
ADHD medications, antidepressants, Anti-Psychotics and Benzodiazepines are made to alter the HPA and in so doing, modify the finely balanced hormone and glandular system of the body.
This is not theory.
Gaba in relation to Benzodiazepines, Serotonin in relation to Antidepressants, Dopamine in relation to Anti-Psychotics, and whatever the relationship with ADHD medication turns into, is not the answer nor is it the reason for a medicationâs effectiveness or lack thereof. Gaba, Serotonin and Dopamine play a submissive role to the HPA. What happens within the HPA determines Gaba, Serotonin and Dopamine.
Gradually treating the HPA and bringing this finely balanced system back in order is The Road Back Program.
An example of the HPA axis at work:
You are walking down a dark side walk at night. You see an evil-looking person directly in front of you. The person pulls a gun from his pocket and points it in your direction. He continues to walk directly toward you. There are a few people around you but you do not know them. As the robber gets closer, you can see he has all of his attention on you. You are going to be robbed and you now know it beyond doubt. What does your body automatically do in reaction to the situation?
1. Your hypothalamus signals your pituitary gland to release the hormone ACTH.
2. ACTH stimulates the secretion of Cortisone (Cortisol, Steroid hormone), Epinephrine (hormone that is released into the bloodstream in response to physical or mental stress, as from fear or injury. It initiates many bodily responses, including the stimulation of heart action and an increase in blood pressure, metabolic rate, and blood glucose concentration. Also called Adrenalin.), and other hormones.
3. Once the Cortisol levels increase, Cortisol will convert your stored Glycogen into blood sugar and create more energy. The adrenal release will increase the energy with its releasing Epinephrine.
4. You will feel your heart pounding due to the Epinephrine.
5. You now begin to sweat due to the Cortisol.
6. Your muscles begin to get tense due to the epinephrine and Cortisol.
7. Your digestion slows. Your bladder and rectum relax.
Now imagine somehow, time is frozen at the point where you are going to be robbed and you now know it without any doubt. Just you and the robber are there but the robber canât complete the action of robbing you and you canât leave or ever realize that the time is frozen. You are totally stuck in that moment in time. But, the inner workings of your body can still change and you can still feel effects from the body.
What begins to happen next? The adrenal glands begin to wear out. The pituitary gland increases ACTH to stimulate the adrenal glands in case you want to attack. More Epinephrine is stimulated by the adrenal medulla, and the total output of Cortisol is increased by the adrenal cortex. The production of the hormone DHEA begins to drop. The body needs more Cortisol to handle the stress and the body tries to accommodate. The adrenals can no longer supply the body with the needed Cortisol to combat the stress. Cortisol levels begin to drop but the ACTH levels remain the same. This puts a further burden on your already confused system.
As the sun begins to rise the next day you begin to feel worse. Around 10 a.m., the body seems to ease up on you for some reason. By noon to early afternoon that same feeling you had in the morning begins to return. At 10 p.m. that evening, your body begins to relax again and that feeling seems to lift until the sun rises again. Then it returns.
Your Cortisol levels are high in the morning and at midday and can still return to normal levels during the nighttime for you. Your body is still pumping Cortisol but other hormones are now suffering. DHEA, Pregnenolone, Testosterone and Estrogen levels are beginning to suffer.
Several days have passed but you are no longer sure how many. ACTH is still rising but the adrenals can no longer keep up with Cortisol production. The relief you once felt at night is gone. The feeling of doom is overwhelming nearly 24 hours a day. (Why not? The body is reacting as though you are perpetually facing doom.) Your adrenals are totally exhausted. You begin to feel changes in your heart. Changes that you know are not good.
You begin to feel depressed. You are gaining weight, you are trembling, you canât remember things you could moments ago, you feel the need for a large cup of coffee or something that is a stimulant, you begin to crave salty food as well as fatty foods or foods high in protein, you have a pain in your upper back and neck but you know you were not injured.
Youâre in a lot of trouble.
You begin to feel like you are starting to get allergies; your skin is dry and seems to be thinner. You feel the symptoms of hypoglycemia; your body temperature is dropping, and your hair is beginning to fall out.
Bad news.
If you are currently taking any psychoactive medication, chances are you have experienced a lot of this body sequence.
With some of these medications, instead of your hypothalamus signaling your pituitary gland to release the hormone ACTH, the hypothalamus is inhibited from releasing ACTH. Other psychoactive medications will induce the release of cortisol continually. The effect on your body is just as damaging.
The problem begins when the body attempts to complete this process. The hypothalamus needs to receive data back when the cycle is complete, to determine if the stress is gone or if you still need ACHT to be ready for âfight or flightâ.
Some people with extreme anxiety or depression experience relief with a Benzodiazepine, Antidepressant or Anti-Psychotic initially, but within one to two months the original symptoms being treated return magnified. The feedback loop to the hypothalamus begins sending incorrect data. Now you have a medication sending a direction to the brain to not release hormones, but the body is stressed and the body knows it needs to produce the corrective hormonesâ¦but is suppressed from doing so.
If you have ever seen or been part of a tug-a-war game, this is whatâs happening in your body to the extreme.
The percentage of the population with diabetes, hormone problems, thyroid problems, adrenal fatigue, and weight gain are increasing at the rate of psychoactive medication prescriptions. We are an increasingly medicated and increasingly ill society.
Anxiety is real, depression is real, and traumatic stress is real, as well as the host of symptoms these medications may be prescribed for are real. However, these very real symptoms only continue to occur within the body while the HPA is out of balance and in the mind until the individual is able to recognize and then dissipate the stored energy that was created at the onset.
Whether you have used psychoactive medication and are still suffering the adverse effects, are currently taking psychoactive medication, or have never used psychoactive medication, balancing the HPA does wonders for overall health and well-being.
There is a reason for the first-thing-in-the-morning anxiety, for the anxiety that seems to come back in the mid-afternoon, and for the exhaustive anxiety you feel at bedtime. There is a reason for fatigue, blood pressure change, blood sugar problems, weight gain, etc.
All psychotropic medications are designed to alter this finely balanced system.
At the physiological level, if you control the Pituitary-Adrenal Axis, you control the body.
Regarding control; there is good control as well as bad control. We can control an atom to the point of making a nuclear bomb. We lose control once the bomb is detonated. The military term "controlled blast" is true to the point where we may know that a certain size of bomb will not blow up our planet, but there is no predicting where each particle from a blast will go.
We might be able to control for a short period of time HPA with medication. But with HPA being what it is, it will not allow any single part of it to be controlled without disruption of the whole.
Gradually treating the HPA and bringing this finely balanced system back in order is The Road Back Program.
The claims, information and products mentioned through this site or within the book, How to Get Off psychiatric Drugs Safely have not been evaluated by the United States Food and Drug Administration and are not approved to diagnose, treat, cure or prevent disease. The information provided on this site or within the book, How to Get Off Psychiatric Drugs Safely is for informational purposes only and is not intended as a substitute for advice from your physician or other healthcare professional. You should not use the information on this site for diagnosis or treatment of any health problem or for prescription of any medication or other treatment. You should consult with a healthcare professional before starting any diet, exercise or supplementation program, before taking any medication, or if you have or suspect you might have a health problem.
Copyright 2006 The Road Back. All rights reserved. No
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! , and had gotten the blues more than most. But I was always very hesitant as I'm not too fond of drugs, or chemicals in general. I also was afraid they would effect my artwork (I'm a painter). But after seeing a mental health office and at the suggestion of my gastrointeroligist I decided to try lexapro. They said it had the least amount of side effects. I researched it a bit, but obviosuly not enough. 
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