There is a blood test to help your doctor make the right
decision as to what antidepressant, if any, is right for you.
Mayo Clinic psychiatrists, in partnership with laboratory
medicine specialists, have developed the cytochrome P450
test that helps pinpoint genetic factors that play a role in a
person's response to various drugs, including most
antidepressant medications.
The cytochrome P450 test represents a major advance
in the ability to provide the best care possible for
depression. This blood test provides information about how
a person's body metabolizes (breaks down) drugs. One
person may metabolize an antidepressant slowly. This can
cause side effects or even a toxic reaction, which might lead
the person to stop taking the drug. Other people may
metabolize the drug quickly, eliminating the drug from the
Each issue, we will bring you an excerpt from "The CFIDS
Chronicle." The following material from the 2005-2006
special issue of the journal lists drugs commonly prescribed
by physicians for treating CFS patients. It's not intended to
be comprehensive, and patients should keep in mind that
what works for one person may not work for them.
Treatments for CFS: Medications
Physicians and patients may need to systematically try
various drug interventions to determine what works best.
People with CFS are highly sensitive to medications, so
dosages are generally started out at a fraction of the
normal dose, and then adjusted to levels that are both
well tolerated and therapeutic.
Sleep Improvement
Sleep initiatiors
Xanax (alprazolam)
Restoril (temazepam)
Klonopin (clonazepam)
Sleep sustainers
Elavil, Endep (amitriptyline
Sinequan (doxepin)
Desyrel (trazodone)
Remeron (mirtazapine)
Zanaflex (tizanidine)
Flexeril (cyclobenzaprine)
Neurontin (gabapentin)
Sleep initiators &
sustainers
Ambien (zolpidem)
Sonata (zaleplon)
Lunesta (eszopiclone)
ProSom (estazolam)
Anticonvulsants
Used in CFS as mood
stabilizers or for pain relief
and sleep
Lamictal (lamotrigine)
Depakote (divalproex
sodium)
Neurontin (gabapentin)
Topamax (topiramate)
Lyrica (pregabalin)
Stimulants
Used in CFS for wakefulness
and mental acuity
Provigil (modafinil)
Aderall (amphetamine salts)
Ritalin (methylphenidate)
Strattera (atomoxetine)
Muscle Relaxants
Used in CFS for pain, sleep
Zanaflex (tizanidine)
Flexeril (cyclobenzaprine)
Skelaxin (metaxalone)
Robaxin (methocarbamol)
Norflex (orphenadrine)
Antidepressants
SSRI class of
antidepressants
Prozac (fluoxetine)
Zoloft (sertraline)
Paxil (paroxetine)
Celexa (citalopram)
Lexapro (escitalopram)
SNRI class of
antidepressants
Effexor (venlafaxine)
Cymbalta (duloxetine)
Wellbutrin (buproprion)
Are Antidepressants Making You Even More Fatigued?
body before benefiting from it. The cytochrome P450 test
gives the doctor information to help choose the right
antidepressant and the correct dosage to reduce side effects.
Your doctor must order the test, and the good news is
that Cape Coral Hospital is affiliated with the Mayo Clinic.
Blood is drawn in the normal way, and the hospital sends it
to the Mayo clinic for assessment. The results are then
returned to your doctor. Check first whether your insurance
will cover the test. (This writer was placed on one
antidepressant after another, all with the same results...bad.
Then, I discovered the test and had it done; it revealed that I
could not metabolize the medications properly.)
Many doctors are not aware of this test, so you may
have to go to the Mayo Clinic web site and print out the
details. Good luck! Michael Golding
Trycyclic class of
antidepressants
Treats Multiple symptoms;
may help with mood, sleep
and pain
Elavil, Endep (amitriptyline)
Sinequan (doxepin)
Norpramin (desipramine)
Receptor antagonist
class of antidepressants
Desyrel (trazodone)
Remeron (mirtazapine)
Restless Legs
Syndrome
Requip (ropinirole)
Mirapex (pramipexole)
Sinemet (carbidopa-
levodopa)
Orthostatic
Intolerance
Florinef (fludrocortisone)
ProAmatine (midodrine)
Tenormin (atenolol)
Analgesics
(Pain Relief)
Nonsteroidal anti-
inflammatory
Advil/Motrin (ibuprofen)
Aleve (naproxen)
Mobic (meloxicam)
Cox II inhibitors
Celebrex (celecoxib)
Analgesic
Tylenol (acetaminophen)
Short-acting
narcotics/opiates
Darvocet-N (propoxyphene)
Various brands containing
oxycodone, codeine or
hydrocodone
Long-acting
narcotics/opiates
MS Contin (morphine sulfate)
Kadian (morphine sulfate)
Avinza (morphine sulfate)
Duragesic (fentanyl
transdermal patch)
Narcotic-like analgesics
Ultram (tramadol)
Ultracet (tramadol with
acetaminophen)
Topical
Lidoderm (lidocaine
transdermal patch)