CHAPTER 22
THE SCIENCE

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INTRODUCTION

The Road Back Program and the Development of the Program:

1. There are basic common denominators of psychotropic drug side effects.

2. How our individual DNA affects drug metabolism.

3. The effect of psychotropic medication within the Hypothalamus-Pituitary-Adrenal Axis and immune system.

4. Utilizing DNA clinical trials, test subject trials and psychotropic drug clinical trials to formulate specific nutritional products creating drug/supplement interactions.

This research and development complexity has been transformed into an easy to understand, systematic program, which allows an individual to taper off their medication while alleviating a vast percentage of the debilitating side effects of withdrawal.

The sequence of this program and the application of each step is the key to success. Your patient will not begin to reduce a medication until the pre-taper is complete. The pre-taper is a 7-day process.

Statements of fact: All psychoactive medications metabolize through specific pathways. All psychoactive medications alter the Hypothalamus Pituitary-Adrenal Axis to some degree. To some extent, you can predict the duration before drug-adverse reactions begin with most psychoactive drugs; if the patient’s P450 (CYP) enzymes have been screened. A poor metabolizer as well as an extensive metabolizer will eventually reach the same saturation point; the poor metabolizer much faster, of course. If one were to look at the basic structure of the human body, the chemical structure of psychiatric drugs, and include how psychiatric drugs are metabolized, how foods, vitamins, minerals, DNA, amino acids, hormones, glands, proteins, fatty acids and enzymes work, in relation to psychiatric drugs, you have The Road Back Science.

The patient has been under some duress and stress before a diagnosis was given and the prescription was written. With this in mind the patients JNK gene would have been overly expressed for some duration. Balancing the JNK gene activation will lead to a normalization of the patient in time.

Drug targets for most disorders will be the purinergic system, the dynorphin opioid neuropeptide system, the cholinergic system (muscarinic and nicotinic systems), the melatonin and serotonin system, and the HPA. One additional reason the supplements were selected to be used in this program, is their natural action of helping to balance the same drug targets.

DNA and Prediction of Drug Adverse Reactions

The following charts detail the P450 enzymes used to metabolize the most common antidepressants, anti-psychotics, benzodiazepines and ADHD stimulant medications. An X in the row denotes that the medication utilizes that specific pathway. Below each chart, you will find other routes of metabolism if applicable.

These medications inhibit metabolism via listed CYP pathways.

Antidepressants  

Marked medications (*) will also use other routes for metabolism:

Adapin – ABCB1-P-pg, UGT1A3, UGT1A4

Anafranil – UGT2B10, CYP3A4, UGT1A4, UGT1A4, UGT2B7, ABCB1-P-gp, CYP3A4

Apo-Amitriptyline – 3A4, UGT2B10, UGT1A4, SLC22A1-OCT1, ABCB1-P-gp, UGT2B7, CYP3A4, CYP2C8, CYP2D6

Apo-Clomipramine – UGT2B10, CYP3A4, UGT1A4,UGT2B7, UGT1A4, UGT1A3

Apo-Doxepin – ABCB1-P-gp, UGT1A3, UGT1A4

Apo-Imipramine – UGT2B10, ABCB1-P-gp, UGT1A4,CYP3A4,SLC22A2-OCT2, UGT1A3, UGT2B7, SLC22A1-OCT1, SLC22A3-OCT3, CYP3A4

Apo-Selegiline – CYP2B6, CYP2C8, CYP3A4, CYP2A6, MAO-B

Apo-Trimip – UGT1A4, CYP3A4, UGT2B10, ABCB1-P-gp

Celexa – ABCB1-P-gp, CYP3A4

Desyrel – CYP3A4, ABCB1-P-gp, P-pg

Effexor – CYP3A4, ABCB1-P-gp, P-gp

Effexor XR – CYP3A4, ABCB1-P-gp, P-gp

Elavil – UGT1A4, UGT1A3, P-gp

Eldepryl – CYP2B6, CYP2C8, CYP3A4, CYP2A6, MAO-B

Lamictal – UGT1A3, UGT2B7, UGT1A4

Ludiomil – ABCB1-P-gp

Luvox – 2B6, P-gp, intestinal 3A, ABCB1-P-gp, CYP2B6, CYP3A4

Norpramin – SLCC22A1-OCT1, SLC22A2-OCT2, SLC22A3-OCT3, CYP3A4

Novo-Doxepin – ABCB1-P-gp, UGT1A3, UGT1A3, UGT1A4

Novo-Selegiline – CYP2B6, CYP2C8, CYP3A4, CYP2A6, MAO-B

Novo-Tripramine – UGT1A4, CYP3A4, UGT2B10, ABCB1-P-gp

Nu-Trimipramine – UGT1A4, CYP3A4, UGT2B10, ABCB1-P-gp

Pamelor – CYP3A4, ABCB1-P-gp, CYP2C8

Paxil – 2B6, P-gp, CYP3A4, CYP2B6, ABCB1-P-gp

Paxil CR – CYP3A4, CYP2B6,ABCR1-P-gp

PMS-Desipramin–SLC22A1-OCT1,SLC22A2-OCT2,SLC22A3-OCT3,CYP3A4                                         

Prozac – 2B6, P-gp, ABCG2-BCRP, SLC22A3-OCT3, CYP3A4, SLC22A1-OCT1, ABCB1-P-gp

Rhotrimine – UGT1A4, CYP3A4, UGT2B10, ABCB1-P-gp

Sarafem – 2B6, P-gp, ABCG2-BCRP, SLC22A3-OCT3,CYP3A4, SLC22A1-OCT1, ABCB1-P-gp

Serzone -- U

Sinequan – UBCB1-P-gp, UGT1A3, UGT1A4

Surmontil – UGT1A4, CYP3A4, UGT2B10, ABCB1-P-gp

Tofranil – UGT1A4, UGT1A3, P-gp,

Triptil – ABCB1-P-gp

Vivactil – ABCB1-P-gp

Wellbutrin – 2E1, 2A6, 2B6, CYP2B6

Wellbutrin SR – CYP2B6

Zoloft – UGT2B7, UGT1A4, P-gp, 2B6, CYP2B6, MAO, CYP3A4, ABCB1-P-gp

Zonalon Topical Crème – ABCB1-P-gp, UGT1A3, UGT1A4

Zyban – CYP2B6

Antipsychotics and Mood Stabilizers 

Marked medications (*) will also use other routes for metabolism:

Apo-Perphenazine – CYP3A4, CES1

Apo-Thioridazine – UGT1A4, ABCB1-P-gp, CYP3A4, CES1

Chlorprom – UGT1A4, UGT1A3, P-gp

Chlorpromanyl – UGT1A4, ABCB1-P-gp

Clozaril – FMO, UGT1A4, UGT1A3, ABCB1-P-gp, FMO3, ABCG2-BCRP

Geodon – Aldehyde oxidase substrate

Haldol – Glucuronidation, P-gp, UGT2B7, CYP3A4, CYP3A5, UGT1A9, ABCB1-P-gp

Haldol Decanoate – UGT2B7, CYP3A4, CYP3A5, UGT1A9, ABCB1-P-gp

Mellaril – CYP3A4, CES1, P-gp

Novo-Chlorpromazine – UGT1A4, ABCB1-P-gp

Novo-Ridazine – UGT1A4, ABCB1-P-gp

Orap – ABCB1 – P-gp, CYP3A4, P-gp

PMS-Perphenazine – UGT1A4, ABCB1-P-gp

Prolixin – P-gp

Risperdal – P-gp, renal extraction, CYP3A4, ABCB1-P-gp, ABCG2-BCRP

Seroquel – Glucuronidation, P-gp, intestinal 3A, epoxide by quetiapine, CYP3A4, ABG2-BCRP, ABCB1-P-gp

Sparine – CYP3A4

Stelazine – UGT1A4, ABCB1-P-gp, P-gp

Thorazine – UGT1A4, UGT1A3, P-gp

Tindal – CYP2A6

Trilafon – CYP3A4, CES1

Zyprexa – Glucuronidation, FMO, UGT1A4

Anti-anxiety, Anticonvulsants, Benzodiazepines, Sleep Medications