Depression, Anxiety, and Bad Drugs

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Sudy
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Depression, Anxiety, and Bad Drugs

Post by Sudy »

I was going to title this thread "Depression, Anxiety, and Bad Pizza", but I had absolutely no reason for the ending other than the cadence appealed to me and it seemed to lighten the mood.

Anyway, I was going to update one of the other anxiety/depression threads I've posted in over the years (e.g. here and here), but it didn't seem appropriate as these were more anxiety-focused and began as other folks' inquiries/stories.

But in short... I'm elated. While it might be early to celebrate, I started a new medication a couple of weeks ago that seems as if it's more-or-less allowed me to have a breakthrough. An edited version of what I shared to the depression subreddit:

Medication isn't right for everyone, and it's rarely the only support needed. As well, many of us may be in regions/circumstances that make accessing the medication that would help us difficult. But if you're currently trying it or hope to be in the future, and it doesn't seem to be helping, be patient and work with your doctor to find the right one(s).

As a 33-year-old who's suffered with depression since at least my teens, and been in formal treatment for eight years trying nearly every SSRI/SNRI under the sun as well as a couple atypicals and a stimulant, I've been prescribed a medication that's had a nearly instant, profound effect on me: Aripiprazole/Abilify. (Actually an atypical antipsychotic more often used to treat schizophrenia and bipolar disorder, in my case prescribed as an add-on to the Escitalopram/Cipralex/Lexapro I'm already taking.) In fact, I've had so little luck with medications before now that I've often wondered whether I'm truly depressed, or if my dysfunction is just the result of my circumstances and choices.

In the last week, I've accomplished more that I've dreaded and procrastinated than I have over the past year, including:

* Calling to change my cell phone plan.
* Activating a replacement credit card.
* Getting exercise close to daily.
* Washing dishes that have accumulated over months.
* Putting up bedroom drapes.
* Easily showering whenever I need to.
* Getting caught up on the laundry.
* Learning how to set up a desktop manager for my cell phone.
* Returning to the optometrist for a checkup a year overdue.
* Going on multiple social outings with my wife and closest friend. (Not very challenging, but I would frequently recoil from even this.)
* Many other small-to-medium tasks, some of which require overcoming social anxiety, and that may not "seem" like a lot, but that I've had a tremendous amount of trouble summoning the mental/emotional energy to do as long as I can remember.

It's like I can just "break through" the mental hurdles that used to delay me or cause me to procrastinate. Is this what it's like to be functional? It's amazing. Maybe it's the combination of the medications I'm on. Maybe it's the placebo effect. Maybe my results are intensified by the fact I'm on vacation from a stressful job at the moment. I also have serious concerns this may be a kind of "hypomania", and I'm wondering if it's possible I've actually been bipolar II all this time with muted manic phases. (I know better than to make an armchair diagnosis... I've already shared my thoughts with my physician and we'll be discussing it at my next appointment.)

One of the downsides is that sleep is difficult. And that is very unusual for me--when depressed, I'm a hypersomniac who uses sleep to escape. Right now, I'm probably getting 3-5 hours a night. But... other than some recurrent daytime drowsiness I tend to experience under normal circumstances, I haven't needed more sleep. This is definitely something we'll need to monitor and work on though, as it isn't sustainable. While I'm fully functional, I think my sharpness and alertness may be dampened as a result.

I'm terrified this is temporary. That it's placebo, or unrelated, or that the drug's effectiveness will taper. I can still feel the depression lurking in the corners of my mind like a dense shadow. But this is a breakthrough, and I'll make the best of it while I'm experiencing it. I have yet to tackle any major projects... that comes next. This is just step one.

Hang in there. Keep trying. Don't give up.

That I'm "over the moon" would be an understatement. If you've made it this far, thanks for reading. I'm so excited, I just had to share.
Last edited by Sudy on Sun May 13, 2018 1:15 pm, edited 1 time in total.

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Re: Depression, Anxiety, and Bad Drugs

Post by tgb »

Congratulations on your breakthrough. Sounds like you're making real progress.
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Re: Depression, Anxiety, and Bad Drugs

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I took prozac for about 15 years. It left me something of a zombie a lot but that was better than not taking it.
I was finally able to drop it here a few years ago. I still have occasional symptoms but it's nice not to be on such things. I hope you can finally come to that stage too.
Good luck!
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Re: Depression, Anxiety, and Bad Drugs

Post by LordMortis »

So happy for you! And for every good story I read.

Change that to Self Imposed Stress, Anxiety, and Bad Drugs and you have me nailed.

You sound similar to me in every way except 1) Depression isn't really my thing 2) I'm 47. I've never made had the fortitude to make it through 8 years of trials at a pop.

I'm glad for you. I'd love to hang in there to get your results but on my next trip in I'm going to ask about options to discontinue. I'd say your situation gives me hope but I think I'm done. I will likely to stay on Provigil if they let me to alleviate some of what you label as Hypersomnia as a symptom but my body can't take the trial and error. My ability to perform a function that achieves a paycheck can't take this trial and error.


May you have continued success. Your success sounds like me on Prednisone, where I feel like JesusSuperman because I feel normal, and it's the one thing they won't give me.
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Re: Depression, Anxiety, and Bad Drugs

Post by em2nought »

I just get everything done in order to keep a business running, and to make sure my mother is taken care of. Reading your list of recent accomplishments makes me wonder if there's something wrong with me though. :think:
Technically, he shouldn't be here.
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Re: Depression, Anxiety, and Bad Drugs

Post by Daehawk »

Congrats. Hope it keeps working as well forever. Having your life back is a alien concept to those who have no idea what you mean.

Speaking of alien you do know Abilify are simply little aliens in stasis? Once ingested they make their way to the base of your brain and sit there taking control. They dont live long though and die each day necessitating the ingestion of another one. Have you checked for a breathing tube / tentacle at the base of your neck? Or they might be using the worm on the hand now. In the old days it was a little green guy on the top of the head but they've advanced enough to be internal now.

I keed. Anyways I probably should be on mind meds but I am too scared of the bad stuff I hear and never take them then tell the doc no thanks. I might actually feel better on something but I keep plodding onward on my own. You toughed the testing out and found your working med. Good for you.
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Re: Depression, Anxiety, and Bad Drugs

Post by Lorini »

It's unfortunate that there's such a stigma and a lot of misinformation attached to anti-depressants and other drugs associated with mental health. No such stigma is attached to heart, lung, or any other 'normal' (<-- this is actually the problem) drugs. If you need medication, get medication.
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Re: Depression, Anxiety, and Bad Drugs

Post by Smoove_B »

Lorini wrote: Sun May 13, 2018 11:44 am If you need medication, get medication.
+1

And just like many other types of medication, it's not a one size fits all application. Different doses, different varieties all might work. Or not. I think that's what's frustrating for many people - very rarely is it a first try is the winner scenario. That and wanting instant results. I have an uncle that was put on medication for anxiety and after a few months, started feeling better. Then, of course, feeling better he stopped taking the medication. Because clearly he didn't need it any more - the medication fixed it! Not surprisingly, he's now a mess again and won't take the meds anymore.

Anyway, glad you found something that worked.
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Re: Depression, Anxiety, and Bad Drugs

Post by Sudy »

Thanks so much for the well-wishes guys. Hope I haven't jinxed it. :wink:
Lorini wrote: Sun May 13, 2018 11:44 am It's unfortunate that there's such a stigma and a lot of misinformation attached to anti-depressants and other drugs associated with mental health.
Yeah... even the bastion of socialized healthcare that's Canada has a way to go on that regard. I think we're really beginning seeing a revolution though, and will see major changes to this thinking in the next generation. Depression and anxiety are tough... they're in part manufactured by modern culture. No doubt anti-depressants are over-prescribed. But for those who need them (and who is anyone to say, other than a patient's doctor?), open the floodgates! What's biochemical is biochemical. If you have the tools, treat the disease.

Daehawk wrote: Sun May 13, 2018 10:45 am Have you checked for a breathing tube / tentacle at the base of your neck?
They told me it was a sebaceous cyst!
Anyways I probably should be on mind meds but I am too scared of the bad stuff I hear and never take them then tell the doc no thanks. I might actually feel better on something but I keep plodding onward on my own. You toughed the testing out and found your working med. Good for you.
Yup... being honest there are some rough side effects, and withdrawal's a bitch. I've gone off my prescription twice within those eight years without consulting my doctor. But, while I can hold down a job and care for my wife (who also suffers from mental illness) in some fashion, I also know that I'm not able to do all that I want/need to. That's made sticking out the treatment worthwhile. But there are those who conquer or manage their struggles without medication. I wish you the very best.

em2nought wrote: Sun May 13, 2018 10:31 am I just get everything done in order to keep a business running, and to make sure my mother is taken care of. Reading your list of recent accomplishments makes me wonder if there's something wrong with me though. :think:
In what regard, may I ask? To me they're such tiny things, but they're still something I struggled to accomplish (or at least, couldn't bring myself to do so sans pressure). Obviously, you don't need to struggle with depression to have issues procrastinating. But there seems to be line of thinking that suggests there's little such thing as "laziness" and most such behaviour stems from anxiety that most people could be helped with.

Though if you're coming at it from the other angle, bear in mind I'm on vacation this week, so I've had lots of time on my hands for the exercise and social outings. ;)

LordMortis wrote: Sun May 13, 2018 10:21 am I'd love to hang in there to get your results but on my next trip in I'm going to ask about options to discontinue. I'd say your situation gives me hope but I think I'm done. I will likely to stay on Provigil if they let me to alleviate some of what you label as Hypersomnia as a symptom but my body can't take the trial and error. My ability to perform a function that achieves a paycheck can't take this trial and error.
Man, I wish I could tell you I didn't understand exactly what you meant. As I hinted at in my response to Daehawk, getting this far has been no picnic, and there's no guarantee this will be a long term success (but my fingers are crossed, as returning to the status quo would be somewhat devastating).

I can really identify with that scene in Silver Linings Playbook in which Bradley Cooper and Jennifer Lawrence are rhyming off all the different medications they've taken. The first one I ever took was accompanied by extreme nausea each morning. (No, it didn't occur to me to pee on a stick.) I never tossed my cookies, as I've always had a strong stomach... but it was still misery. The bigger long term frustrations have been a propensity to sweat (and I already sweat a lot, being overweight) and anorgasmia/reduced sexual function. My doctor tried me on some add-ons to help with this... at one point he even gave me a sample of little blue pills. But it's always been an issue.

Along with the expense for some of the newer medications I've tried, the side effects are the primary reasons I've quit taking them on my own twice over the years. Being depressed sucks, but at least my body worked normally (for me) when I was off them. That can be a trigger in itself. But, presuming Abilify gives me a shot at indefinite relief, it's a price I'd gladly pay twice over. I also hope the best for you.

I saw a commercial on late night TV. It said, "Forget everything you know about slipcovers." So I did. And it was a load off my mind. Then the commercial tried to sell me slipcovers, and I didn't know what the hell they were. -- Mitch Hedberg
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Re: Depression, Anxiety, and Bad Drugs

Post by Kraken »

One hallmark of depression is resistance to seeking care -- one feels hopeless or unworthy, or lacks the energy, or simply doesn't care enough to bother. So making that first effort is a big step, and it's easy to give up if the first drug fails, or even if it just takes a couple of weeks to kick in. Kudos to Sudy for hanging in there.

I've been on antidepressants since before there were SSRIs -- and believe me, the old tricyclic drugs were awful. The only one that worked for me caused cottonmouth, constipation, and dizziness, and alcohol was strictly forbidden. Since then I've tried many SSRIs with varying effectiveness and side effects, none of them ideal. For the past 10-or-so years I've been on a small dose of Wellbutrin. I don't really notice that it affects me unless I stop taking it...then my anxiety returns. I become agitated and I get the jangles that often accompany withdrawal. Wife can always tell when I'm off my meds. I'm still a morose person and I might do better on a different drug, but I'm not clinically depressed (except from December through March, which is normal) and prefer to leave well enough alone.

Last winter I used a "HappyLight" (groan) that someone gave me to combat seasonal depression. Maybe it helped a little, or maybe it didn't. It is hard to perceive incremental changes in one's own mental state.
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Re: Depression, Anxiety, and Bad Drugs

Post by Sudy »

Kraken wrote: Sun May 13, 2018 1:03 pm It is hard to perceive incremental changes in one's own mental state.
Man... like I hinted in my initial post but which bears repeating, there were times I wasn't even certain I was clinically depressed. This medication being so effective feels like the first "proof" I've ever had. I felt like I had some limited success on some of the others, but never to the extent that I no longer needed to sit in place dreading my life for 10 minutes before taking a shower on a workday (or just skipping the shower entirely). And then I'd usually be late. Mind you, we'll see if my punctuality is actually any better when I return to work after this week. The drug-intensified sweats are still liable to slow me down.

I saw a commercial on late night TV. It said, "Forget everything you know about slipcovers." So I did. And it was a load off my mind. Then the commercial tried to sell me slipcovers, and I didn't know what the hell they were. -- Mitch Hedberg
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Re: Depression, Anxiety, and Bad Drugs

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Re: Depression, Anxiety, and Bad Drugs

Post by Sudy »

Wow. Yup. +100

I saw a commercial on late night TV. It said, "Forget everything you know about slipcovers." So I did. And it was a load off my mind. Then the commercial tried to sell me slipcovers, and I didn't know what the hell they were. -- Mitch Hedberg
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Re: Depression, Anxiety, and Bad Drugs

Post by paulbaxter »

So good to hear! I think depression, and probably other mental issues as well, can seem like they'll never end, so I can feel your excitement at doing better.

Now time to get into a good rhythm of doing good and healthy things.
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Re: Depression, Anxiety, and Bad Drugs

Post by Holman »

So glad to hear things are working!
paulbaxter wrote: Sun May 13, 2018 3:23 pm
Now time to get into a good rhythm of doing good and healthy things.
+1 to this. The best thing the drugs can do for you (or me) is clear space for making positive and helpful changes.
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Re: Depression, Anxiety, and Bad Drugs

Post by hitbyambulance »

Holman wrote: Sun May 13, 2018 3:32 pm So glad to hear things are working!
paulbaxter wrote: Sun May 13, 2018 3:23 pm
Now time to get into a good rhythm of doing good and healthy things.
+1 to this. The best thing the drugs can do for you (or me) is clear space for making positive and helpful changes.
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Re: Depression, Anxiety, and Bad Drugs

Post by Jaddison »

I just finished Johann Hari's book Lost Connections: Uncovering the Real Causes of Depression - and the Unexpected Solutions because his first book on addiction was exactly what he said- everything I thought about addiction was wrong.

Highly recommend this book. Well researched and again, most everything I thought about depression was wrong.

https://smile.amazon.com/Lost-Connectio ... 499&sr=8-2
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Re: Depression, Anxiety, and Bad Drugs

Post by Paingod »

I'm glad this is working for you.

My mother went through a round of prescriptions when she got into therapy and claims it changed her world, and made her happy again. From the outside looking in, she became annoying and kept pushing for everyone to be happy like she was.

I sometimes wonder if I'd benefit from being medicated. I wouldn't say I'm depressed all the time - but my natural state is extremely neutral, not happy. It's easy for me to get sad, pretty easy to return to neutral, and happiness is fleeting. I don't ever get excited about anything and can't say I could describe "elation" to anyone. Because I'm not happy, people assume I'm down - truth be told, I'm not down; I'm just not up.

I've always assumed this was who I was and was fine with it.
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Re: Depression, Anxiety, and Bad Drugs

Post by Xmann »

I've battled mild depression and moderate to severe anxiety for years. I started taking Wellbutrin almost a year now and it's truly changed my life. I was starting to move into a dark place and thankfully I swallowed my pride and asked for help.

My only regret is waiting so long to get help and realize how much of an asshole I was to my family.

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Re: Depression, Anxiety, and Bad Drugs

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Jaddison wrote: Mon May 14, 2018 8:07 am I just finished Johann Hari's book Lost Connections: Uncovering the Real Causes of Depression - and the Unexpected Solutions because his first book on addiction was exactly what he said- everything I thought about addiction was wrong.

Highly recommend this book. Well researched and again, most everything I thought about depression was wrong.

https://smile.amazon.com/Lost-Connectio ... 499&sr=8-2
The sample of that book that I read didn't mention any scientific research whatsoever, just his testimonials, which is not enough for me to be convinced of his suggested approach.
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Re: Depression, Anxiety, and Bad Drugs

Post by Jaddison »

I read the book and it references studies and research every step of the way which was also true of Chasing the Scream

On the Kindle the last 30% of book is references to studies and research.
Here is the very first part of references for the first chapter, references for Chapter 1 are 3 pages long.
Chapter 1: The Wand
What could possibly be going on? John Haygarth, Of the Imagination as a Cause And as a Cure of Disorders of the Body, Exemplified by Fictitious Tractors and Epidemical Convulsions (London: R. Crutwell, 1800); Stewart Justman, “Imagination’s Trickery: The Discovery of the Placebo Effect,” The Journal of the Historical Society 10, no. 1 (March 2010): 57–73, doi: 10.1111/j.1540-5923.2009.00292.x, as accessed January 1, 2016; Joel Falack and Julia M. Wright, eds., A Handbook of Romanticism Studies (Chichester, West Sussex, UK; Malden, MA: Wiley, 2012), 31–2; Heather R. Beatty, Nervous Disease in Late Eighteenth-Century Britain: The Reality of a Fashionable Disorder (London; Vermont: Pickering and Chatto, 2011). Irving Kirsch sat Irving Kirsch, The Emperor’s New Drugs: Exploding the Antidepressant Myth (London: Bodley Head, 2009), 1.

Hari, Johann. Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions (p. 255). Bloomsbury Publishing. Kindle Edition.
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Re: Depression, Anxiety, and Bad Drugs

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Those aren’t references relating to what he’s telling you to do. I don’t see any clinical trials of this method among them or university studies. When those happen I’ll take what he’s saying seriously. He’s handpicking studies to make his point, that’s not at all the same as what cognitive behavioral therapy went through to become a standard practice among therapists.
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Re: Depression, Anxiety, and Bad Drugs

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I'm not sure what you think the book is about but it did not come across as him preaching a certain way. The strongest argument he makes is big pharma pushing pills and also the changes to the guidelines on diagnosing depression that essentially do allow anytime for grief (iirc it has gone from 6 weeks to 0 over the years).
Both his books broadened my perspective. YMMV
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Re: Depression, Anxiety, and Bad Drugs

Post by Fitzy »

Congratulations Sudy. I know the struggle and it’s hard journey. It’s a wonderful feeling when you find something that works.
Jaddison wrote: Mon May 14, 2018 9:09 pm also the changes to the guidelines on diagnosing depression that essentially do allow anytime for grief (iirc it has gone from 6 weeks to 0 over the years).
Do you have a source for this other than the book in question?

The DSM5, uses a two week minimum, with symptoms required most days. Bereavement was removed as an exclusion, but the literature supported this. It is a clinical judgement as to whether or not the situation should merit a diagnosis of depression. It is not a requirement. No clinical guidelines I’ve ever seen equate grief with depression. Grief can, but does not always, exist in tandem with depression. The DSM5 provides guidelines for separating the two.
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Re: Depression, Anxiety, and Bad Drugs

Post by Jaddison »

Here are the references for this from the book. Not an expert in the field, i read the book and found it interesting and to me there are a lot of references for the type of book this is, i think, meant to be.

Over the years that followed, Joanne In this chapter I draw on much of Joanne’s published work. See Joanne Cacciatore and Kara Thieleman, “When a Child Dies: A Critical Analysis of Grief-Related Controversies in DSM-5,” Research on Social Work Practice 24, no. 1 (Jan. 2014): 114–122; Cacciatore and Thieleman, “The DSM-5 and the Bereavement Exclusion: A Call for Critical Evaluation,” Social Work (2013), doi: 10.1093/sw/swt021; Jeffrey R. Lacasse and Joanne Cacciatore, “Prescribing of Psychiatric Medication to Bereaved Parents Following Perinatal/Neonatal Death: An Observational Study,” Death Studies 38, no. 9 (2014); Cacciatore, “A Parent’s Tears: Primary Results from the Traumatic Experiences and Resiliency Study,” Omega: Journal of Death and Dying 68, no. 3 (Oct. 2013–2014): 183–205; Cacciatore and Thieleman, “Pharmacological Treatment Following Traumatic Bereavement: A Case Series,” Journal of Loss and Trauma 17, no. 6 (July 2012): 557–579. “became known as the ‘grief exception’ ” I first learned about the grief exception from the brilliant work of Gary Greenberg, which I recommend strongly. See: Book of Woe (New York: Penguin, 2013), 6, 158–60; Manufacturing Depression: The Secret History of a Modern Disease (London: Bloomsbury, 2010), 246–8; John Read and Pete Sanders, A Straight-Talking Introduction to the Causes of Mental Health Problems (Herefordshire, UK: PCCS Books, 2013), 60, 88–91. But once you’ve conceded that One of the leading authors of the fourth edition of the DSM, Robert Spitzer, tacitly admitted this. See The Therapy Trap, p. 49, and my friend Adam Curtis’s BBC documentary The Trap. “we don’t consider context.” Other key figures in writing the DSM have admitted this. See William Davies, The Happiness Industry: How the Government and Big Business Sold Us Well-Being (New York: Verso, 2016), 174. There’s just the checklist of symptoms See American Psychiatric Association, Diagnostic and Manual of Mental Disorders, 5th Edition (Washington, DC: American Psychiatric Publishing, 2013), 155–189. The vague footnote is on p. 126.

Hari, Johann. Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions (p. 255). Bloomsbury Publishing. Kindle Edition.
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Re: Depression, Anxiety, and Bad Drugs

Post by Pyperkub »

Sudy - I'm really glad for you. I do have a question as it sounds like you've been through a lot with regards to this. How did they determine what drug(s) might work for you? Was it pretty much trial and error? Do they do any blood work or have any scientific way of evaluating what the right drug for a person's brain chemistry is?
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Re: Depression, Anxiety, and Bad Drugs

Post by Sudy »

I've been struck with some waves of depression anxiety over the past couple days that I've had trouble suppressing. But I'm still doing better than normal. I'm starting to sleep a little longer, but I'm still psyched to get out of bed (and way earlier than I usually would). Still have yet to begin some of the major projects I'd like to, but I continue to make small strides. I'm eager to see my doctor again for an evaluation in June.

I've been reading that Abilify, about 10 years ago, was actually vilified as being overmarketed and needlessly prescribed to depression patients. Many practitioners viewed its potential side effects as being unworthy of the risk. I don't know if the thinking may have changed since then. But given that I've been a patient for 7+ years without significant improvement, I think it's use is probably warranted.
Pyperkub wrote: Wed May 16, 2018 5:58 pm Sudy - I'm really glad for you. I do have a question as it sounds like you've been through a lot with regards to this. How did they determine what drug(s) might work for you? Was it pretty much trial and error? Do they do any blood work or have any scientific way of evaluating what the right drug for a person's brain chemistry is?
Primarily trial and error. While I've had blood work performed, I don't think it was related to my mental health outside of checking for vitamin D deficiency. I did get to participate in a trial/study that involved a "spit in a tube" test resulting in suggestions for which anti-depressants might best suit my physiology in the sense of which were more likely to stay in my system for a longer period, etc. But this wasn't a regular treatment option.

My original G.P. actually retired from family practice a couple years in. But I recall him saying that he usually only prescribed anti-depressants for around a year, and that they should always be accompanied by therapy. But while there are limited community mental health resources in my region (probably much better than what you can get for free in many areas of the U.S., but still limited), I've either had little success with them or haven't really been able to access them due to needing/being able to work full-time during this period.

I saw a commercial on late night TV. It said, "Forget everything you know about slipcovers." So I did. And it was a load off my mind. Then the commercial tried to sell me slipcovers, and I didn't know what the hell they were. -- Mitch Hedberg
Roman
Posts: 1133
Joined: Thu Oct 14, 2004 4:13 pm
Location: Earth

Re: Depression, Anxiety, and Bad Drugs

Post by Roman »

Thought I would share something here with you all.

There is a study here in Toronto being conducted by CAMH (Centre for Addiction & Mental Health)
The study is called IMPACT.

http://impact.camhx.ca/en/home.php

They will study your DNA (saliva and cheek swabs) and then tell you what medications will not metabolize based on your particular DNA makeup. The study will also suggest a medication that should metabolize. Results are available within 5 days.

Magic bullet? Who knows - but it sure beats the hell out of trial and error across all sorts of medications that are supposed to work for you but aren't

Maybe there is something like that where you all live? Doctor's referral is of course required.

Roman
While feeding all the beasties out back I let a nice big fart. The smell followed all the way back to the house. It's like it was my baby and felt abandoned.
User avatar
dbt1949
Posts: 25688
Joined: Wed Oct 13, 2004 12:34 am
Location: Hogeye Arkansas

Re: Depression, Anxiety, and Bad Drugs

Post by dbt1949 »

I wish the VA had something like that. I swear half the drugs I take don't work very well.
Ye Olde Farte
Double Ought Forty
aka dbt1949
Roman
Posts: 1133
Joined: Thu Oct 14, 2004 4:13 pm
Location: Earth

Re: Depression, Anxiety, and Bad Drugs

Post by Roman »

I'll email the programme contact and ask if they know of any US studies.
While feeding all the beasties out back I let a nice big fart. The smell followed all the way back to the house. It's like it was my baby and felt abandoned.
User avatar
LordMortis
Posts: 70101
Joined: Tue Oct 12, 2004 11:26 pm

Re: Depression, Anxiety, and Bad Drugs

Post by LordMortis »

Roman wrote: Mon Jul 30, 2018 3:58 pm Thought I would share something here with you all.

There is a study here in Toronto being conducted by CAMH (Centre for Addiction & Mental Health)
The study is called IMPACT.

http://impact.camhx.ca/en/home.php

They will study your DNA (saliva and cheek swabs) and then tell you what medications will not metabolize based on your particular DNA makeup. The study will also suggest a medication that should metabolize. Results are available within 5 days.

Magic bullet? Who knows - but it sure beats the hell out of trial and error across all sorts of medications that are supposed to work for you but aren't

Maybe there is something like that where you all live? Doctor's referral is of course required.

Roman

My PCP recommended genetic screening to me with regard to medications and my miserable experiences with head meds some months ago but he said no one covers it and it is expensive but it's out there (or here in the US)

Also as I word on hope, before my insrurers went FUBAR and I lost my shrink I was put on Modafinil (Provigil mentioned above). It's not Jesus or anything, like prednisone is, but it takes a bite out of my exhaustion. Before being excommunicated by my new insurance, my shrink said she believes my the sleep doctor that has me on a CPAP should be able to keep me on Mdafinil as a supplement to my CPAP as long as I am compliant to my CPAP usage (which has done nothing to alleviate my exhaustion). Waiting on the next visit with my sleep doctor.

Google says!!!

pharmacogenomics

http://mayoresearch.mayo.edu/center-for ... esting.asp
urrent Limitations of Pharmacogenomics Tests

Current limitations of pharmacogenomics testing include:

One single pharmacogenomic test cannot be used to determine how you will respond to all medications. You may need more than one pharmacogenomic test if you are taking more than one medication.
Pharmacogenomic tests are not available for all medications. Because pharmacogenomic tests are available only for certain medications, your health care provider determines if you need to have a pharmacogenomic test prior to beginning a specific treatment.
There are currently no pharmacogenomic tests for aspirin and many over-the-counter pain relievers.

Pharmacogenomics Testing Costs and Coverage

The cost of pharmacogenomics testing varies depending on which test is ordered and your health insurance coverage. To help you determine test costs and coverage:

Mayo Clinic’s Patient Account Services may be able to provide an estimate by phone.
Some insurance companies may cover pharmacogenomic testing, depending on the policy and reasons for testing.
Contact your insurance provider about coverage prior to testing if cost and coverage are concerns.
It may be helpful to get the ICD-9/ICD-10 procedure and CPT billing codes for the specific lab tests from your health care provider before calling the insurance company.

A federal law called the Genetic Information Nondiscrimination Act (GINA) generally makes it illegal for health insurance companies to discriminate against you based on your genetic information. This federal law does not protect you against genetic discrimination by life insurance, disability insurance or long-term care insurance companies. Some states have laws in this area.
First vendor I found. Can't vouch for anything about them. $400

https://www.pathway.com/mental-health-dna-insight/

I'm not smart enough to understand nor do I have time to digest the whole thing but from the look of it my provider rejects the idea of screen drug metabolism based on genetic testing.

http://www.aetna.com/cpb/medical/data/700_799/0715.html

So I'ma guess no on the coverage and given my experience with transition of care nightmares, I'm guessing that using Pharmacogenomics Testing might be grounds for them to reject a claim made on my behalf by a physician.

Sample from latest publication July 10, this year

What they claim to cover and how. Lawbeef!!!!! explain!!!!
Spoiler:
ACPT Codes / HCPCS Codes / ICD-10 Codes
Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":
Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":
Code Code Description
Genotyping for CYP2C19:
CPT codes covered if selection criteria are met:
81225 CYP2C19 (cytochrome P450, family 2, subfamily C, polypeptide 19) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3, *4, *8, *17)
CPT codes not covered for indications listed in the CPB:
81227 CYP2C9 (cytochrome P450, family 2, subfamily C, polypeptide 9) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3, *5, *6)
ICD-hyphen10 codes covered if selection criteria are met:
I25.10 -hyphen I25.9 Chronic ischemic heart disease
Genotyping for CYP2D6:
CPT codes covered if selection criteria are met:
0028U CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg, drug metabolism) gene analysis, copy number variants, common variants with reflex to targeted sequence analysis
81226 CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3, *4, *5, *6, *9, *10, *17, *19, *29, *35, *41, *1XN, *2XN, *4XN)
Other HCPCS codes related to the CPB:
J1800 Injection, propranolol HCl, up to 1 mg
ICD-hyphen10 codes covered if selection criteria are met:
E75.22 Gaucher disease [for persons with Gaucher's disease type 1 who are being considered for treatment with eligustat (Cerdelga)]
G10 Huntington's disease [Tetrabenazine (Xenazine) is indicated for the treatment of chorea associated with Huntington’s disease]
Genotyping for cytochrome P450:
No specific code
CPT code not covered for indications listed in the CPB:
0029U Drug metabolism (adverse drug reactions and drug response), targeted sequence analysis (ie, CYP1A2, CYP2C19, CYP2C9, CYP2D6, CYP3A4, CYP3A5, CYP4F2, SLCO1B1, VKORC1 and rs12777823)
0030U Drug metabolism (warfarin drug response), targeted sequence analysis (ie, CYP2C9, CYP4F2, VKORC1, rs12777823)
0031U CYP1A2 (cytochrome P450 family 1, subfamily A, member 2)(eg, drug metabolism) gene analysis, common variants (ie, *1F, *1K, *6, *7)
81230 CYP3A4 (cytochrome P450 family 3 subfamily A member 4) (eg, drug metabolism), gene analysis, common variant(s) (eg, *2, *22)
81231 CYP3A5 (cytochrome P450 family 3 subfamily A member 5) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3, *4, *5, *6, *7)
81232 DPYD (dihydropyrimidine dehydrogenase) (eg, 5-hyphenfluorouracil/5-hyphenFU and capecitabine drug metabolism), gene analysis, common variant(s) (eg, *2A, *4, *5, *6)
81346 TYMS (thymidylate synthetase) (eg, 5-hyphenfluorouracil/5-hyphenFU drug metabolism), gene analysis, common variant(s) (eg, tandem repeat variant)
CPT codes related to the CPB:
81400 -hyphen 81408 Molecular pathology
HCPCS codes not covered for indications listed in the CPB:
G9143 Warfarin responsiveness testing by genetic technique using any method, any number of specimen(s)
Other HCPCS codes related to the CPB:
J0640 Injection, leucovorin calcium, per 50 mg
J1630 Injection, haloperidol, up to 5 mg
J1631 Injection, haloperidol decanoate, per 50 mg
J2270 Injection, morphine sulfate, up to 10 mg
J2271 Injection, morphine sulfate, 100 mg
J2275 Injection, morphine sulfate (preservative-hyphenfree sterile solution), per 10 mg
J2794 Injection, risperidone, long acting, 0.5 mg
J3310 Injection, perphenazine, up to 5 mg
J3360 Injection, diazepam, up to 5 mg
J8530 Cyclophosphamide, oral, 25 mg
J9070 Cyclophosphamide, 100 mg
J9190 Fluorouracil, 500 mg
J9206 Irinotecan, 20 mg
J9263 Injection, oxaliplatin, 0.5 mg
Q0175 Perphenazine, 4 mg, oral, FDA approved prescription anti-hyphenemetic, for use as a complete therapeutic substitute for an IV anti-hyphenemetic at the time of chemotherapy treatment, not to exceed a 48-hyphenhour dosage regimen
S0093 Injection, morphine sulfate, 500 mg (loading doe for infusion pump)
S0187 Tamoxifen citrate, oral, 10 mg
ICD-hyphen10 codes not covered for indications listed in the CPB:
G30. 0 -hyphen G30.9 Alzheimer's disease
CYP2C19 polymorphisms testing for fluoxetine:
CPT codes not covered for indications listed in the CPB:
81225 CYP2C19 (cytochrome P450, family 2, subfamily C, polypeptide 19) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3, *4, *8, *17)
UGT1A1 molecular assay:
CPT codes not covered for indications listed in the CPB:
81350 UGT1A1 (UDP glucuronosyltransferase 1 family, polypeptide A1) (eg, irinotecan metabolism), gene analysis, common variants (eg, *28, *36, *37)
Other HCPCS codes related to the CPB:
J9206 Irinotecan, 20 mg
ICD-hyphen10 codes not covered for indications listed in the CPB:

C00.0 -hyphen C7A.8, C7B.1, C76.0 -hyphen C86.6,
C88.4 -hyphen C94.32, C94.80 -hyphen C96.4,
C96.6 -hyphen C96.9

Malignant neoplasms
D00.00 -hyphen D09.9 In situ neoplasms
D45 Polycythemia vera
VKORC1 polymorphism:
CPT codes not covered for indications listed in the CPB:
81355 VKORC1 (vitamin K epoxide reductase complex, subunit 1) (eg, warfarin metabolism), gene analysis, common variant(s) (eg, -hyphen1639G>A, c.173+1000C>T)
HLA-hyphenB*1502:
No specific codes
HLA-hyphenB*5701:
No specific code
ICD-hyphen10 codes covered if selection criteria are met:
B20 Human immunodeficiency virus [HIV] disease
Z21 Asymptomatic human immunodeficiency virus [HIV] infection status
Genotyping for apolipoprotein E (Apo E):
No specific code
Other CPT codes related to the CPB :
88271 -hyphen 88275 Molecular cytogenetics
ICD-hyphen10 codes not covered for indications listed in the CPB (not all-hypheninclusive):
E71.30 Disorder of fatty-hyphenacid metabolism, unspecified
E75.5 -hyphen E75.6 Other and unspecified lipid storage disorders

E78.0 -hyphen E78.5, E78.70, E78.79 -hyphen E78.9

Disorders of lipoprotein metabolism and other lipidemias
E88.2 Lipomatosis, not elsewhere classified
E88.89 Other specified metabolic disorders
Genotyping for methylenetetrahydrofolate reductase (MTHFR):
CPT codes not covered for indictions listed in the CPB :
81291 MTHFR (5,10-hyphenmethylenetetrahydrofolate reductase) (eg, hereditary hypercoagulability) gene analysis, common variants (eg, 677T, 1298C)
ICD-hyphen10 codes not covered for indications listed in the CPB (not all-hypheninclusive):

C00.0 -hyphen C7A.8, C7B.1, C76.0 -hyphen C86.6,
C88.4 -hyphen C94.32, C94.80 -hyphen C96.4,
C96.6 -hyphen C96.9

Malignant neoplasms
D00.00 -hyphen D09.9 In situ neoplasms
D45 Polycythemia vera
Measurement of thromboxane metabolites in urine:
CPT codes not covered for indications listed in the CPB:
84431 Thromboxane metabolite(s), including thromboxane if performed, urine
BRAF V600E or V600K mutations (e.g., the THxID BRAF test):
CPT codes covered if selection criteria are met:
81210 BRAF (B-hyphenRaf proto-hyphenoncogene, serine/threonine kinase) (eg, colon cancer, melanoma), gene analysis, V600 variant(s)
ICD-hyphen10 codes covered by indications listed in the CPB:
C43.0 -hyphen C43.9 Malignant melanoma of skin
NS3 Q80K polymorphism, NS5A resistance-hyphenassociated polymorphisms:
CPT codes covered if selection criteria are met:
87900 Infectious agent drug susceptibility phenotype prediction using regularly updated genotypic bioinformatics [for persons with hepatitis C virus (HCV) genotype 1a infection being considered for treatment with simeprevir (Olysio)] [for persons with hepatitis C virus (HCV) genotype 1, 3 and 4 infections being considered for treatment with daclatasvir (Daklinza) or elbasvir and grazoprevir (Zepatier)]
87902 Infectious agent genotype analysis by nucleic acid (DNA or RNA); Hepatitis C virus [for persons with hepatitis C virus (HCV) genotype 1a infection being considered for treatment with simeprevir (Olysio)] [for persons with hepatitis C virus (HCV) genotype 1, 3 and 4 infections being considered for treatment with daclatasvir (Daklinza) or elbasvir and grazoprevir (Zepatier)]
ICD-hyphen10 codes covered if selection criteria are met:
B17.10 -hyphenB17.11 Acute hepatitis C without/with hepatic coma [genotype 1, 1a, 3, 4 infections]
B18.2 Chronic viral hepatitis C [genotype 1, 1a, 3, 4 infections]
B19.20 -hyphen B19.21 Unspecified viral hepatitis C [genotype 1, 1a, 3, 4 infections]
Z22.52 Carrier of viral hepatitis C [genotype 1, 1a, 3, 4 infections]
BRACAnalysis CDx, FoundationFocus CDxBRCA:
CPT codes covered if selection criteria are met:
81162 BRCA1, BRCA2 (breast cancer 1 and 2) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis and full duplication/deletion analysis
81211 BRCA1, BRCA2 (breast cancer 1 and 2) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis and common duplication/deletion variants in BRCA1 (ie, exon 13 del 3.835kb, exon 13 dup 6kb, exon 14-hyphen20 del 26kb, exon 22 del 510bp, exon 8-hyphen9 del 7.1kb)
ICD-hyphen10 codes covered if selection criteria are met:
C50.011 -hyphen C50.929 Malignant neoplasm of breast [HER2-hyphennegative]
C56.1 -hyphen C56.9 Malignant neoplasm of ovary
BRAF and NRAS mutations (e.g., cobas KRAS Mutation Test; therascreen KRAS RGQ PCR Kit):
CPT codes covered if selection criteria are met:
81210 BRAF (B-hyphenRaf proto-hyphenoncogene, serine/threonine kinase) (eg, colon cancer, melanoma), gene analysis, V600 variant(s)
81311 NRAS (neuroblastoma RAS viral [v-hyphenras] oncogene homolog) (eg, colorectal carcinoma), gene analysis, variants in exon 2 (eg, codons 12 and 13) and exon 3 (eg, codon 61)
Other HCPCS codes related to the CPB:
J9055 Injection, cetuximab, 10 mg
J9303 Injection, panitumumab, 10 mg
ICD-hyphen10 codes covered if selection criteria are met:
C18.0 -hyphen C20 Malignant neoplasm of colon, rectosigmoid junction and rectum
Epidermal growth factor receptor (EGFR) T790 mutation; exon 19 deletions or exon 21 (L858R) substitution mutations (e.g., cobas EGFR Mutation Test, therascreen EGFR RGQ PCR Kit):
CPT codes covered if selection criteria are met:
81235 EGFR ( epidermal growth factor receptor) (eg, non-hyphensmall cell lung cancer) gene analysis, common variants (eg, exon 19 LREA deletion, L858R, T790M, G719A, G719S, L861Q)
ICD-hyphen10 codes covered if selection criteria are met:
C34.00 -hyphen C34.92 Malignant neoplasm of bronchus and lung [non-hyphensmall cell lung carcinoma]
PD-hyphenL1 expression (e.g., PD-hyphenL1 IHC 22C3 pharmDx, Ventana PD-hyphenL1 (SP263) Assay):
CPT codes covered if selection criteria are met:
88360 Morphometric analysis, tumor immunohistochemistry (eg, Her-hyphen2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, per specimen, each single antibody stain procedure; manual
88361 using computer-hyphenassisted technology
Other HCPCS codes related to the CPB:
J9271 Injection, pembrolizumab, 1 mg
ICD-hyphen10 codes covered if selection criteria are met:
C65.1 -hyphen C65.9 Malignant neoplasm of renal pelvis [urothelial carcinoma]
C66.1 -hyphen C66.9 Malignant neoplasm of ureter [urothelial carcinoma]
C67.0 -hyphen C67.9 Malignant neoplasm of bladder, unspecified [urothelial carcinoma]
C68.0 -hyphen C68.9 Malignant neoplasm of other and unspecified urinary organs [urothelial carcinoma]
Platelet-hyphenderived growth factor receptor-hyphenbeta (PDGFRß) gene rearrangements (e.g., PDGFRB FISH):
CPT codes covered if selection criteria are met:
88271 Molecular cytogenetics; DNA probe, each (eg, FISH)
88275 interphase in situ hybridization, analyze 100-hyphen300 cells
ICD-hyphen10 codes covered if selection criteria are met:
C93.10 -hyphen C93.12 Chronic myelomonocytic leukemia
FTL3 mutation assay (e.g., LeukoStrat CDx FLT Mutation Assay):
CPT codes covered if selection criteria are met:
0023U Oncology (acute myelogenous leukemia), DNA, genotyping of internal tandem duplication, p.D835, p.I836, using mononuclear cells, reported as detection or non-hyphendetection of FLT3 mutation and indication for or against the use of midostaurin
81245 FLT3 (fms-hyphenrelated tyrosine kinase 3) (eg, acute nyeloid leukemia), gene analysis; internal tandem duplication (ITD) variants (ie, exons 14, 15)
81246 tyrosine kinase domain (TKD) variants (eg D835, I836)
ICD-hyphen10 codes covered if selection criteria are met:
C92.00 -hyphen C92.02 Myeloid leukemia
Measurement of microsatellite instability and mismatch repair:
CPT codes covered if selection criteria are met:
81301 Microsatellite instability analysis (eg, hereditary non-hyphenpolyposis colorectal cancer, Lynch syndrome) of markers for mismatch repair deficiency (eg, BAT25, BAT26), includes comparison of neoplastic and normal tissue, if performed
88341 Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure)
88342 Immunohistochemistry or immunocytochemistry, per specimen; initial single antibody stain procedure [mismatch repair]
Other HCPCS codes related to the CPB:
J9271 Injection, pembrolizumab, 1 mg
ICD-hyphen10 codes covered if selection criteria are met:
C00.0 -hyphen C14.8 Malignant neoplasm of lip, oral cavity and pharynx
C15.3 -hyphen C26.9 Malignant neoplasm of digestive organs
C30.0 -hyphen C39.9 Malignant neoplasm of respiratory and intrathoracic organs
C40.00 -hyphen C41.9 Malignant neoplasm of bone and articular cartilage
C49.0 -hyphen C49.9 Malignant neoplasm of other connective and soft tissue
C7A.00 -hyphen C7A.8 Malignant neuroendocrine tumors
Extended RAS Panel -hyphen no specific code:
Anaplastic lymphoma kinase (ALK) fusion gene testing, (Vysis ALK Break Apart FISH Probe Kit; Ventana ALK (D5F3) CDx Assay):
No specific code
ICD-hyphen10 codes covered if selection criteria are met:
C34.00 -hyphen C34.92 Malignant neoplasm of bronchus and lung [non-hyphensmall cell lung carcinoma]
Genotyping for IL28B polymorphism:
ICD-hyphen10 codes not covered for indications listed in the CPB:
B19.20 Unspecified viral hepatitis C without hepatic coma
rs3798220 allele testing:
No specific code
ICD-hyphen10 codes not covered for indications listed in the CPB:
Z79.82 Long-hyphenterm (current) use of aspirin
G551D, G1244E, G1349D, G178R, G551S, R117H, S1251N, S1255P, S549N, and S549R mutation in the CFTR testing:
No specific code
ICD-hyphen10 covered for indications listed in the CPB:
E84.0 -hyphen E84.9 Cystic fibrosis [who are being considered for treatment with ivacaftor (Kalydeco)]
F508del mutation in the CFTR testing:
CPT codes covered if selection criteria are met:
81222 CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis) gene analysis; duplication/deletion variants
ICD-hyphen10 codes covered for indications listed in the CPB:
E84.0-hyphenE84.9 Cystic fibrosis [who are being considered for treatment with lumacaftor/ivacaftor (Orkambi)]
GeneSightRx testing (GeneSight ADHD, GeneSight Analgesic, GeneSight MTHFR and GeneSight Psychotropic):
No specific code
ICD-hyphen10 codes not covered for indications listed in the CPB:
F30.10 -hyphen F39 Mood [affective] disorders
Platelet reactivity/function testing (VerifyNow P2Y12 Assay):
No specific code
ICD-hyphen10 codes not covered for indications listed in the CPB:
Z98.61 Coronary angioplasty status
OnDose lab test:
HCPCS codes not covered for indications listed in the CPB:
S3722 Dose optimization by area under the curve (AUC) analysis, for infusional 5-hyphenFluorouracil
MGMT (O(6)-hyphenmethylguanine-hyphenDNA methyltransferase) gene methylation Assay:
CPT codes covered if selection criteria are met:
81287 MGMT (O-hyphen6-hyphenmethylguanine-hyphenDNA methyltransferase) (eg, glioblastoma multiforme), methylation analysis
Other HCPCS codes related to the CPB:
J8700 Temozolomide, oral, 5 mg
J9328 Injection, temozolomide, 1 mg
ICD-hyphen10 covered for indications listed in the CPB:
C71.0 -hyphen C71.9 Malignant neoplasm of brain [glioblastoma]
Genecept Assay:
No specific code
ICD-hyphen10 codes not covered for indications listed in the CPB (not all inclusive):
F20.0 -hyphen F20.9 Schizophrenia
F30.10 -hyphen F39 Mood [affective] disorders
F32.0 -hyphen F32.9 Major depressive disorders
F34.0 -hyphen F34.9 Persistent mood [affective] disorders
F40.00 -hyphen F48.9 Anxiety, dissociative, stress-hyphenrelated, somatoform and other nonpsychotic mental disorders
F90.1 -hyphen F90.9 Attention-hyphendeficit hyperactivity disorder
Beta adrenergic receptor genotyping:
CPT codes not covered for indications listed in the CPB:
81401 VKORC1 (vitamin K epoxide reductase complex, subunit 1) (eg, warfarin metabolism), gene analysis, common variant(s) (eg, -hyphen1639G>A, c.173+1000C>T)
ICD-hyphen10 codes not covered for indications listed in the CPB:
J45.20 -hyphen J45.998 Asthma [treatment resistant]
Methotrexate polyglutamates (Avise PG test):
No specific code
Other HCPCS codes related to the CPB:
J8610 Methotrexate; oral, 2.5 mg
J9250 Methotrexate sodium, 5 mg
J9260 Methotrexate sodium, 50 mg
ICD-hyphen10 codes not covered for indications listed in the CPB (not all inclusive):
M05.00 -hyphen M14.89 Inflammatory polyarthropathies
Millennium PGT:
No specific code
ICD-hyphen10 codes not covered for indications listed in the CPB (not all inclusive):
G89.21 -hyphen G89.29 Chronic pain, not elsewhere classified
PersonaGene Genetic Panels:
CPT codes not covered for indications listed in the CPB:
81225 CYP2C19 (cytochrome P450, family 2, subfamily C, polypeptide 19) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3, *4, *8, *17)
81226 CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3, *4, *5, *6, *9, *10, *17, *19, *29, *35, *41, *1XN, *2XN, *4XN)
81227 CYP2C9 (cytochrome P450, family 2, subfamily C, polypeptide 9) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3, *5, *6)
81240 F2 (prothrombin, coagulation factor II) (eg, hereditary hypercoagulability) gene analysis, 20210G>A variant
81241 F5 (coagulation factor V) (eg, hereditary hypercoagulability) gene analysis, Leiden variant
81291 MTHFR (5,10-hyphenmethylenetetrahydrofolate reductase) (eg, hereditary hypercoagulability) gene analysis, common variants (eg, 677T, 1298C)
81355 VKORC1 (vitamin K epoxide reductase complex, subunit 1) (eg, warfarin metabolism), gene analysis, common variant(s) (eg, -hyphen1639G>A, c.173+1000C>T)
81401 VKORC1 (vitamin K epoxide reductase complex, subunit 1) (eg, warfarin metabolism), gene analysis, common variant(s) (eg, -hyphen1639G>A, c.173+1000C>T)
ICD-hyphen10 codes not covered for indications listed in the CPB (not all inclusive):
Z51.81 Encounter for therapeutic drug level monitoring
HLA-hyphenB 58:01:
CPT codes covered if selection criteria are met:
No specific code
Aegis Drug-hyphenDrug Interaction Test:
CPT codes not covered for indications listed in the CPB:
0006U Prescription drug monitoring, 120 or more drugs and substances, definitive tandem mass spectrometry with chromatography, urine, qualitative report of presence (including quantitative levels, when detected) or absence of each drug or substance with description and severity of potential interactions, with identified substances, per date of service
OneOme RightMed Pharmacogenomic Test:
CPT codes not covered for indications listed in the CPB:
0015U Drug metabolism (adverse drug reactions), DNA, 22 drug metabolism and transporter genes, real-hyphentime PCR, blood or buccal swab, genotype and metabolizer status for therapeutic decision support
Genotyping of interferon-hyphenlambda 3 (IFNL3) for prediction of virological response to pegylated-hypheninterferon-hyphenalpha and ribavirin combination therapy:
CPT codes not covered for indications listed in the CPB:
81283 IFNL3 (interferon, lambda 3) (eg, drug response), gene analysis, rs12979860 variant
PGxOnePlus genetic testing -hyphen no specific code:
ICD-hyphen10 codes not covered for indications listed in the CPB (not all inclusive):
F40.00 -hyphen F48.9 Anxiety, dissociative, stress-hyphenrelated, somatoform and other nonpsychotic mental disorders

K21.0, K21.9

Gastro-hyphenesophageal reflux disease with or without esophagitis
UrSure tenofovir quantification test:
CPT codes not covered for indications listed in the CPB:
0025U Tenofovir, by liquid chromatography with tandem mass spectrometry (LC-hyphenMS/MS), urine, quantitative
ICD-hyphen10 codes not covered for indications listed in the CPB (not all inclusive):
Z20.6 Contact with and (suspected) exposure to human immunodeficiency virus [HIV]
Z20.828 Contact with and (suspected) exposure to other viral communicable diseases
Experimental and Investigation Treatment -hyphen no specific codes:
A1555G, Amerigene PGT pharmacogenetic testing panel, Proove Profiles (including Proove Opioid Risk Panel, Proove Opioid Response Profile, Proove Non-hyphenopioid Response Profile, Proove Opioid-hyphenInduced Side Effects Profile, Proove NSAID Risk Profile, Proove Fibromyalgia Profile, Proove Epidural with Fentanyl Response Profile, Proove MAT (Medically Assisted Treatment) Response Profile, Proove TMD Profile, Proove Psychiatric Risk and Response Profile, Proove Addiction Profile, Proove Narcotic Risk Panel, Proove Drug Metabolism Panel, rxSEEK Epilepsy Drug Metabolism Test (Courtagen LIfe Sciences
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