June 30, 2008

A Series of Events (Part I) - Prologue

This past weekend was met with mixed results for yours truly. There were some very happy moments, and there were also a few unpleasant ones as well.

Sunday specifically led the charge of both extreme personal highs and emotional lows in which I am still trying to digest and wrap my brain around in conjunctuion with Christ's words on peace, grace, and calming my inner spirit.

Let me first start by saying that after almost two weeks of various allergy medications that have messed with me in more ways than one, my rash or 'hives' finally seem to be under control. I'm not sure if I ever mentioned it here before, but back in 2006 I developed a very serious skin rash. Something I never had never experienced before and it scared me as well as being very miserable on both a physical and emotional level.

We were on vacation when my body began to swell up. My skin developed 'hives' of such an intense nature my skin felt as if it were on fire....literally radiating heat to the touch and causing extreme discomfort with the persistant 'itchiness' of it all. Since we were on vacation at the time, my local doctor was nowhere to be had. I ended up going to an emergency room in a far off city to have injections of ephedrine and cortisone and placed on a knee-jerk perscription of anti-inflammatories, anti-histimines, and anti-itch meds. They had a very limited effect at the time and I suffered for the next few days until I could return home and see my regular doctor, who in turn recommended me to a dermatologist.

The dermatologist took two skin biopsies from my leg and blood samples and sent them off for testing. While my hives did not get any worse, I was not really improving either. And to be quite honest, I sorta looked like a walking freakshow. You wouldn't believe the stares I was getting, and the swelling did temproarily disfigure my face. My forehead and bridge of my nose was so bad, it looked as if my eyes shifted an additional inch away from each other.

My blood work came back as did the biopsy reports a few days later, and both can back negative. I suppose that's the good news....no wierd tropical disease or cancer or virus. However, the bad news was that no one had an explanation as to what brought it on or even had a guess to what I may have had. I have never in my life had that before and we all sat around scratching our heads as to what may have been the trigger.

That was May of 2006. It is now June 2008 and I can tell you I have had the incident repeat itself a total of 5-6 additional times. I have since seen an allergist and have had my blood tested again and a full work up of allergy tests (skin scrapes). My blood still tests negative (normal), and allergy tests have only confirmed what I already knew....a few certain foods, some grasses, weeds, molds, etc. that most people are allergic to anyway and didn't seem to be a trigger for it.

Fortunately it has never been as bad as the initial time and I have learned how to detect the onset (feelings) at its earliest stages so I can attempt a premeditated strike of medications. I can't stop it, but I have learned how to lessen its impact and try to become as comfortable as I can under the circumstances.

The various doctors I have been seeing 'think' they may now know what I have: Chronic Uticaria. I say 'think' because they are not 100% positive, bit nothing else fits the symptoms right now. The bad news is there really is no effective cure, nor does science know exactly what causes it. So it appears that I developed a condition out of nowhere in May 2006 and will be subject to it the remainder of my natural life...with tons of pills in plastic containers ready to take at a moments notice. God forbid I get another illness and have to combine even more drugs.

The symptoms today: swollen hands and some facial swelling, itchiness of the scalp and hands, some discomfort in normal breathing, and probably the most visible cue - red 'splotches' on my head, neck, arms, thighs, sides of body and can include my hands and feet, and at times, radiate heat.

Here are a few things I have to do: stay cool and out of direct sun for long periods of time. No extreme physical exertion (no gym, no intense labor, avoid projects that I have to use my hands alot), watch my stress levels and blood pressure, try an avoid scratching as best I can when I itch. Take cool showers. Take anti-histamines. Take anti-inflamatories. Take steroids.

So you're probably wondering why I am going into all this detail now. Well, I suppose I'm just giving you some background information on me to help set up my next few posts about this weekend.

To be continued....

June 27, 2008

A few minor changes

Depending on how much you visit here, you may or may not have noticed a few minor additions and changes.

I've made a few color changes to the sidebar just to 'spice' things up a bit, hopefully to add a little life and pizzaz to my thoughts.

I also added a picture of Christ. There are so many beautiful pictures of Jesus out there, most of them reflecting a long haired man in a serene pose with his arms either oustretched as if to say "Welcome my child", or looking down with his head slightly tilted down to one side that sort of reflects a certain humbleness yet authority of being King of kings.

I chose the one I did because it was a close up of Him looking right at you, nothing else to get in the way but His connection with you. I also like the muted sepia like colors and its worn look.

Finally in case anyone is interested, I also added a subcription feed button that will notify the reader when a new post/entry or comment is updated here. By selecting the appropriate button, you can then add a 'feed' to one of the more popular 'subscription readers' available. I've never used one before so I don't know excatly how it works. Please let me know what you think.

In other news, the Lord does indeed work in mysterious ways. My wife had dinner with her mother and sister yesterday and got home later than I expected....I actually thought they were having lunch, not dinner, but I'm sure I heard wrong. The nice thing was my wife brought me home dinner, one of my favorite meals, though I wish she would have called me earlier to let me know because when she got home I was eating leftovers anyways. But the fact is she thought of me which I guess is a nice surprise.

She didn't go into much detail, but indicated her sister was lecturing her. I didn't want to press matters or inquire as to what, but I can guess. I imagine her sister may have raised some concerns that a few people have noticed the last few months in regards to her recent behaviors. I didn't ask her sister to do so, but I'm not going to turn down the outside help either. Her sister once confided in me not that long ago that she was a little concerned about my wife priorities in general and the way she acts towards me on occassion. That was nice to hear on one hand, that someone may have finally noticed and at least gave me some inkling that all this 'stuff' isn't just me be overly sensitive. It also bothered me too, because it appears my ability to contain it and put on a happy-smiley face is always working, and now her side of the family must know that things aren't as rosey as them may first seem.

I dunno. Time will tell and I continue to pray for a more positive future, however, past experience also resulted in a short period of being nice only to revert to the standard ways in a few weeks.

Other than that little blurb on the radar from yesterday, I strangely feel somewhat calm and at peace today. Work is very quiet which is nice and I imagine this weekend will afford me some time to finally relax at home and maybe play some games I've been wanting to play.

I'm even looking forward to my men's support/bible study group this Saturday too.

June 25, 2008

Getting up early

Yesterday was a very busy day at work. It was both nice and tiring at the same time.

It was nice on the one hand as the day went by relatively fast, and I have always tended to work well under pressure. I usually perform well when pushed up against a wall or deadline...not usre why, just do.

On the other hand, between my cold sore and other medicines, I alternate between feeling wired and wiped out. Like my body is on cruise control and I'm not 100% in control of the gas pedal.

I came home yesterday to discover my wife was already home. She said she had not been feeling well but was nice enough to make me dinner. I did a few chores outside, helped clean up the kitchen a bit, and had to work on my PC to remove the malware that had infected it earlier this week.

I had a strange dream last night. One that I am not proud of, but can't help but wonder why my subconcious has been working over time and clearly I have some issues that need to be worked on.

Basically I dreamed I met another woman who was in love with me, and promised and appeared to be everything I first thought about my own wife. In my 'dream state', I had the comforting and secure feeling that this 'other' woman wanted to have a child with me...actually looked forward to attempting a family. She was also very nice and polite and was open about attending church. She didn't smoke, nor did she make social drinking a priority with neighbors and friends.

In my dream I was 'tempted' to have an affair, but as much as I knew this 'woman' was everything I thought I wanted, I also explained to her that I had made a contract with God on my current marriage vows....and became slighty disheartened in knowing that I could not be with her. I could not break those vows no matter how discouraged and frustrated and hurt I can get at times. I imagined a life with my wife whom I love.....but always feel I will come in second place.....or I move ahead with a new relationship and perhaps someday be able to be happy with this 'dream' person who I knew put me first for a change.

When I did wake up early this morning, I had that gnawing feeling of shame in my head for these subliminal dreams, and yet I do not want to discuss them at all with my wife. I wonder if all this is just a build up from the last few days and my imagination is getting the best of me.

June 24, 2008

A new round of tests and counseling (Part IV)

It's been over a week, probably closer to two since I last posted. It's not that I haven't thought about it, it's more or less a result of being a little lazy and other stressors in my life that stop me from sitting down and composing my thoughts.

The last week has been a whirlwind, at least to me.....our water heater needed to be replaced after we discovered a leak in our garage. Needless to say it ended up being very complicated and not easy and we were without hot water for about 3 days. So it was cold showers, no dishes, and limited laundry. Never really realized how much we depend on that thing afterall.

It has also been exceedingly hot in our area, easily breaking 100 degrees this past Friday through Sunday, and I'm sure with a combination of stress and the high temperatures my 'hives' were in full bloom. I've been taking a lot or Predisone for that and anti-histamines. In addition, I developed a very nasty looking cold-sore/fever-sore and my gums ache.

Saturday my wife invited a bunch of neighbors over for a BBQ without asking me first...I really wasn't in the mood, but she's already asked and people committed. That irritates me as well....she knows I have a rash, we have no hot water, and I've barely slept....but who cares about my input? Let's have a BBQ anyway. When she was preparing the meat for the BBQ, I wanted to make a simple suggestion on how to tie it up. I was actually trying to be helpful, but instead I got snapped at: "I KNOW how to season a pork butt..." I just shut up and walked away....funny thing is, I wasn't even talking about seasoning...I was gonna talk about tying it up. It's moments like these I just wonder why I am where I am, and I just need to walk away.

Is it wrong to feel that I wish karma would bite my own wife in the rear once in a while? I feel ashamed for thinking that way, and it isn't very Christian like at all....but I sometimes....I just wish she's get knocked down a peg or two by someone else to know how it feels when people are just trying to help. I could go on and on about this too....I think it's the absence of the Holy Spirit in her life that tends to make her nasty at times when she talks to me. She doesn't talk this way to her friends and neighbors, or even her parents.....it just seems to be me.

Lastly, my PC got some malware installed (my fault) which basically made my computer unusabel unless I installed some anti-spyware software from a fraudulant internet based company that ended up charging me $86 when it was only supposed to be $39. That's just another thing I have to battle with the CC company and hopefully get a refund.

So, I haven't had much time or desire for anything else....including attending church. I stayed home Sunday morning and just sat and watched TV, walked my dog early (before the heat kicked in again), stayed on my various meds, and tried to enjoy the silence.

When I get cranky, and my patience is alrady at a low, I don't understand why the universe feels the need to make sure my phones rings nonstop for the dumbest reasons. I had telemarketers calling me all day Sunday, plus my mother has an uncanny ability to sense when something is wrong and will call all day long, unrelenting until I pick up. I wish she'd get the hint once in a while that I need my solitude and I don't always want to talk about things when it's convienent for everyone else. I find it tedious, tiresome, and highly irritable.... Then my wife asks why I'm being an ass. Well, I'm being an ass I suppose because everyone can't give me any space when I need it. Why don't people realize that I am not feeling well, hot, on various medications, have a skin rash, can't do laundry and dishes, have a cold sore, not sleeping well....and they want to know why I'm not more upbeat.

So I haven't gone in to take my treadmill 'stress' test yet. I keep putting it off. I have also put off the second round of marriage-counseling at the church that my wife won't attend. I debate whether it really does any good or not....if my wife doesn't want to go, or continues to live in denial, what good is it for me to go solo? I feel it's just an uphill battle that I'll end up losing emotionally anyway not to mention suck up a few hours of time. The last time I went, it may have been therapuetic....but I really didn't get the sense the peson I was talking too cared all that much. I mean how could they after they meet with me only 2 times at 1 hour each and my wife wasn't there to express her side? I look back and think the whole experience was like talking to a brick wall. So there's a part of me that hasn't followed up because I just don't see the point.

June 09, 2008

A new round of tests and counseling (Part III)

I always find that the typical 'lines of communication' between my wife and I are often reversed by most stereotypical standards. Meaning, my wife often plays the role of the stubborn male who doesn't want to talk about things, clam-up, and eventually pretend it didn't happen, whereas I on the other hand don't like the silent treatment and look for the 'fix' now so I can move on and not dwell on it. I honestly feel in my heart I am the more open of the two of us, much more willing to admit my own faults and seek and dole out foregiveness when the time is right.



I came home that night fully expecting to be questioned when she walked in the door, but instead was more or less ignored the first hour or so. I personally haven't decided if I like this general reaction or not. Sometimes I feel like there is an elephant in the room that no one wants to talk about....other times I'm thankful nothing is being said as I am just too tired or mentally/emotionally exhausted to go another round.



Speaking of 'rounds', it also often seems to me that our 'discussions', if you will, are only given attention when she wants to, not me. Myabe that sounds nit-picky on my behalf, but I've come to realize that she often sets the terms on when we 'discuss' issues....when she's up to it or wants to, not me.



Surprisngly, by the end of the night she was speaking to me again, but never once referred to the previous few days of tension. She also never asked me once on how the doctor visit went either. My own stubborn and wounded ego wasn't going to offer it up either if not asked. I'm not going to tell my wife I am experiencing mild panic attacks, crying in front of my doctor, and especially being hooked up to an EKG machine if she didn't care.



The next few days seemed to get much better, although some of her occasional comments come across as a mild irritant or back handed slap on occassion. They do sting me on the inside, and I'm very aware of what she says to who, but I try very hard not to let on and look like it bothers me. Why provide more fuel to the fire?

I'm starting to lose my train of thought here, so perhaps I'll close this entry today. It's as if my thought, while coherent in the here and now, aren't going to make sense or flow logically as I continue.

Suffice to say, I feel better today than I have the last few days, but I'm not 100% sure why. My wife and I nevere really seem to achive a resolution to our 'issues'...they just seem to keep getting shelved from time to time until one is brave enough to go on the attack, or perhaps muster enough courage and strength to put the defenses and say "Okay, take your shot now while I have a moment of actual interest to defend myself."

This medicine just wipes me out.

June 05, 2008

A new round of tests and counseling (Part II)

I met my confidant over at the church and we were able to secure a regular classroom to talk.

I sat across from him at a large table in grade school like chairs and removed my sun glasses. I told him to give me a minute as I needed to collect my thoughts as I really didn't have time to prepare what I was going to say. Bless his heart on his patience with me.

I decided that the best course of action, if I really wanted some 'real' advice was to give him the full skinny. A brief synopsis of the past few years. I told him about when I started to feel a personality shift within me, when things weren't always looking so rosy anymore, my ups and downs in marriage, the panic attacks, the hives, the inability to have a child, the job loss, the death of my uncle, the medication, the shrinks, the anger/confusion/abandonment feelings from God, the guilt and shame I feel when I look in the mirror, the hatred I was developing for people and situations in general, my insecurities, and finally the thoughts of 'giving-up'.

Amazingly I did it in under 10 minutes. I tried to be succinct and to maintain my composure the best I could, but it was a relief, and I sobbed.

He listened without interruption and took a few minutes himself to digest.

He then shared some of his own struggles throughout his life and shared that he also felt similar things at various times in his life. But the key he said he felt about me, and his observations on me the last months was that God didn't abandon me, nor I abandon God.....the fact was I did not feel I was worthy of God's grace and forgiveness...that I could not accept the fact that I was 'saved'...that I felt I must continually work at penance (most likely from my Catholic roots). To sum it up...I have never taken the time to forgive myself, even though Christ did. And until I came to that realization and acceptance, I would never be internally happy. If I could not feel His love and peace and accept I was forgiven, the darkness would always be present and would boil over into all facets of my life.

And the devil knows this, and uses this this to make my life miserable here on earth. He further explained that since I was already 'forgiven' and 'saved', that Satan has already lost the war on my soul, but was sure to press my buttons here in my mortal shell to always make me think I am unworthy of God's peace and grace.

He told me that I should read the book of Romans, particularly chapter 8.

So now there is no condemnation for those who belong to Christ Jesus. For the power of the life giving Spirit has freed you through Christ Jesus from the power of sin that leads to death. (Romans 8: 1-2)

Our conversation lasted a total of just over an hour, and there was some quiet times, a few more tears, a lot of self introspection. Though I was still feeling bad, it was nice to unload, and to unload on someone who didn't appear to judge me, or ask me weird questions about my upbringing, mommy issues, sexual trauma, etc. I felt genuine concern and advice and care from this person. He wants to talk again in the next few days to see how I'm doing, and he gave me a book from C.S. Lewis called the 'Screwtape Letters' he wants me to read. It's a novel about two demons who plot and scheme to mess with peoples minds, and all the tricks of the trade to make us humans feel unworthy of God's love, filling our minds and hearts with doubt, self-pity, confusion, etc. I promised I would indeed read it.

We walked out together silently and he said a prayer with me.

Now the next hurdle of the day....going home and facing my wife and the rest of the night.

To be continued....

June 04, 2008

A new round of tests and counseling (Part I)

With my hives out of control (I'm now convinced that they are indeed related to my ungodly stress level) I left work early to see my doctor. Surprisingly I weighed in a bit less than I thought I was going to...a diet consisting of worry and heartache can do wonders for the waistline.

I sat in the office dreading the conversation, because I knew my chart would pull up my past medical history which would also include Lexapro & Clonzapam and sleep medication.

The nice doctor sat in front of me, took a look at my skin, took my blood pressure, asked me the standard battery of questions and decided to talk to me about stress, insomnia, and my breathing. I was of course honest. I told him I have a history of mild panic attacks. He then asked me more about my stress, (I could see what was coming next and I swore I wasn't going to tear up.) and asked if there was anything currently going on. I told him there was some problems at home, and of course my eyes began to well up. He handed me a tissue.

Then the kicker: "Do you want to hurt yourself?"...."No. Not now", I repsonded.

"Have you had sucicidal thoughts?".....I sighed very deeply..."Yes, maybe a few years back."

It just hung out there for a minute.

"Have you see a psychiatrist?"......"Yes, but in honesty....I don't think it helped. All it accomplished was making my wallet lighter."

"You need to see one again son." He handed me a pamphlet on managing stress. I had a hard time looking him in the eye at that moment. I hate those pamphlets...like some stupid tri-leaf telling me to exercise more, hang around exciting people, and talk about my problems, accented by goofy cartoon figures is gonna solve my problems.

"We want to do an EKG on you as long as you are here."

I laid back down on the table and a nurse came in and labeled my skin in various pint with diodes and what not and a machine was wheeled in to measure my heart. The test took about 5 minutes and was painless, and the doctor returned after a few to discuss the results.

"Well, it looks okay....However, I'd like to send you to another facility for a treadmill stress test. Do that and we'll talk again."

He wrote me out a perscription for some steroids for my rash and I was on my way.

I sauntered out to the parking lot where my car was and just sat down in the driver seat again for a few minutes. I could feel the warmth emmanating from my cloth seats from being in the sun and glanced again at the stress pamphlet. Just glanced and turned it over...didn't read it. I've read it 100 times before.

It's now 4:30 pm. I decide I need to talk to someone else...a confidant from my church. I give him a ring and thankfully he is home. I simply ask if he can meet me to talk. I really don't know what I want to say, but he's going to meet me in 15 minutes at our church.

I think about this for a minute, and can't help but think about it again as I sit and type out this entry.....I don't want to tell my parents....I don't want to tell my in-laws.....I don't want to talk to my childhood friends.....I don't even want to tell my wife right now (and honestly, I'm not sure she's even understand...she hasn't before, so why would today be any diffrent). Yes, I called a elder in my church to be around with for a while....possibly to vent....just some companionship really.....I just want someone to listen who isn't related and doesn't want my money for a change.

I'm off to meet him....

to be continued.....

June 03, 2008

A new low

I'm taking a break from by child rearing and infant related posts for a few days because it appears I have taken a major step back in both my relationship with my wife, my struggles with spirituality, and my health.

First my health: Years ago before I started seeking medical help for what I was concluding was depression, one of the other symptoms I was experiencing was a tightening in my chest, a difficulty of both swallowing and breathing, and an overall restless and fidgety feeling. At times it could be somewhat very uncomfortable and borderline painful. The pain seems to center just behind my sternum and feels like someone is squeezing a ball within my chest. I tried to hide my discomfort from both family and friends, and at first thinking I was just having a very bad case of indigestion...but there was never any gas or burning reflux associated with it.

When I had my blood pressure taken, it was a bit high despite a well balanced diet and considerable exercise. In short I came to learn that a certain amount of stress was leading to mild to intermediate level panic attacks. They could come at any time: at rest or at work, eating or not....A sense of dire urgency would rush over my system and almost leave me incapacitated. The quick cure was sedatives, or more commonly pills which I am to take when I sense an onset to help calm me down. The doctor was a bit concerend about my high blood pressure despite relatively normal blood panels. I was a time bomb ticking...and on rare occasion still am. I came to learn that certain triggers also mirrored my mental stability and my onset of depression.

Well, those feelings of anxiety have returned again recently. I have had a few 'mild' experiences over the past two weeks, enough so where I have taken a few pills to try and relax.

Another side effect of stress is that I develop hives. Very inflamatory hives over the surface of my body. I have seen a regular doctor, a dermatologist, a blood specialist, and finally an allergist. I have biopsies of my skin taken, blood drawn, full panel allergy tests and they all come back with nothing out of the ordinary. A medicine cocktail of Predisone, Zyrtec, Benadryl, Ratadine, and anti itch cream is the general course of action. Sometimes they help, sometimes they don't.

My wife is very angry with me again too, and to be honest, I seriously don't know why. I personally thought I was doing her a favor the other day, actually going out of my way for her to do do something that I thought she'd appreciate. Well, not only was it not appreciated, which was a surprise, it landed me in the doghouse, in my own house where I was read the riot act. The riot act was peppered with strong language and I'll admit that not only was I stunned and speechless, I couldn't get a word in edge wise even if I wanted to. I tried, but she wasn't listening. She didn't want to listen. Her mind was made up on something that was not true and even Johnny Cochran wouldn't be able to explain it away to her. I really fought the temptation to get mad and rage right back. I can only sit there for so long getting raked over the coals and not be expected to say something in my defense. There was even a brief second my anger was mounting so high, I may have taken a swing at her and I'm ashamed at that. Despite my crying and sensitive nature, I am a big guy and there is no doubt I could hurt someone physically if I don't keep myself in check.

This makes me terribly sad and hurt. More hurt that I can put into words right now and perhaps a factor in why my hives and rash are so out of control right now. I have no outlet for my pain and grief and frustration other than my tears and teh strength of God almighty....but I'll be honest....I don't think God is particularly listening to me right now. We are taught that God never abandons us, never leaves if we call, that He is only a prayer away. I'm ashamed to say to right now that I feel as if He is taking a smoke break when I call upon Him. As if I leave a message at the heavenly switchboard and it just get erased or never passed on.

My wife has pretty much banned me from speaking with her parents and sister regarding 'our' issues, and more or less wishes I didn't speak to my parents as well. That would be opening up yet another pandoras box in her eyes and the ire is unmistakenable. But Heck, she doesn't want to listen to me and I really have no one else to vent to, which tends to just make my problems fester and be contained within myself and I want to scream at the top of my lungs.

I sit and feel I have no one to go to, lest I seek a counsler at $100+ dollars an hour just to tell me I may have 'mommy' issues. I've asked my wife to go to marriage counseling with me, but she has flat out said no. I feel as I am trapped at times, with a person who says she loves me and occasionally does show her affection....but its very few and far apart. There is much more bad than good right now, and it hurts me so much to know how much I love a person and I feel that as if she takes me for granted the majority of the time. It seems I am constantly walking on eggshells, and I can't help but wonder if my whole marriage will be like this from here on out. It hasn't even been 5 years. Can I go another 5? 10? A lifetime on being on the shortend of the stick no matter what I try and do?

I've also been told that marriage is sacred, a holy contract. I've been taught that God only gives us so much as we can handle. I'm really starting to question these things. Both my physical and mental health are constantly in flux or beaten down. My will to please and to sacrifice anymore is rapidly depleting. My emotional tank is depleting fast. I don't think my wife loves me the way she used to or said she did years ago. I am tired of being so alone and not being able to talk to anyone except strangers who want to charge me money I don't have the luxury of spending.

Right now I feel at an all time low, and quiet frankly my life, my marriage, my sanity.....they all suck...and that's a mild word of how I am actually feeling. I look back at my life right now and I am despretly trying to locate the timeframe where everything began going south. I can't find it.

Seriously, I hate my life right now. I truly, unequivically HATE my existance.

June 02, 2008

Miracle Drug, Poison or Placebo? Part III

Here is the conclusion of the 3 part article by Maia Szalavitz. Part III:


Other Factors


Unfortunately, most of these results failed to be replicated when researchers looked for them again. “People find predictors of response all the time but they are almost never replicated,” says Roy Perlis, M.D., an assistant professor of psychiatry at Harvard Medical School.


Genetic diversity may complicate the story. For example, one gene associated with positive response to antidepressants in whites was associated with lack of response in Japanese and Korean people.


The environment matters too—one study found that people who had been abused in childhood were less likely to respond to medicationsand more likely to be helped by talk therapy.


To complicate matters even further, it’s not just brain genes that affect drug response, but also a system of enzymes in the liver in which there is also great genetic variation.


For example, the enzyme CYP450 2D6 metabolizes Prozac and some related drugs and there are numerous variants of this one enzyme alone that can affect the way these drugs work. People whose 2D6 breaks down Prozac too fast may get no effect from ordinary dosages of the drug. Conversely, those whose enzyme works slowly may have severe side effects even at low dosages. A genetic test that is now commercially available can determine which variant someone has— but there’s another wrinkle.


Dietary factors significantly affect the actions of various enzymes. You may have heard of grapefruit juice negatively affecting the impact of drugs, but char-broiled meat, broccoli, star fruit, alcohol and tobacco also affect the response to medications. In addition, interactions between numerous medications can make things even less predictable.


“For the majority of people, these tests are not useful for antidepressant prescribing,” Perlis concludes. However, for people with bipolar disorder or psychotic depression who use antipsychotic medications, the tests can be important, particularly in terms of preventing serious side effects.


“It’s a nice idea,” concludes Tranter. “A lot of people are very interested in using genetics to predict the response to medication, but it’s too early to know what it will yield.”


Treating Depression Step By Step


But although trial and error and doctors’ clinical intuition are still all we really have to go on in antidepressant choice, a large study examining treatment of depression in real-world practice found that most people did benefit significantly by the end of the trial. Unlike a clinical trial, which usually just compares a drug to placebo or another drug, this trial involved trying different drugs sequentially if the first ones didn’t work for particular patients.


“Two-thirds got better by the end of the steps,” says Madhukar Trivedi, M.D., professor of psychiatry at the University of Texas Southwestern Medical School. “And by better, I mean that almost all the symptoms were gone—they were in remission. Not just showing improvement.”