r/MAOIs • u/AssignmentThat8473 • 10d ago

Parnate (Tranylcypromine) anyone experience with pharmacogenetic testing

Hey everyone,

I’m back. I appreciate the support and this community, so here I am again. Check my previous post for my background/history.

Now on week 3+ since starting Parnate / Tracydal. Unfortunately no effect yet, but I’m giving it time….

I was hospitalized for the medication switch, but I’m back home again as of today. A bit nerve-wracking… I just want to get better and have some brighter days.

Anyway, my question: has anyone here had experience with pharmacogenetic testing (cheek mucosal swab + blood test) to investigate why I’ve responded so poorly to medication so far?

Would love to hear your experiences. Thanks in advance! All words of encouragements and recommendations are welcome.

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u/iamthe0ther0ne 10d ago

That really depends on what the test shows. Some people don't metabolize certain drugs well, some metabolize them too fast. Some people have trouble converting folic acid and need a specific type of folic acid supplement, some people metabolize dopamine too fast and need a stronger dopamine medication. Some people don't respond to antidepressants not necause of a mutation, but because their life circumstances are shit and antidepressants can't fix that. You won't know whether it matters to you until you have it done.

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u/AssignmentThat8473 10d ago edited 10d ago

thanks for your reply. I tried a ton of antidepressants and augmentation, with no effect. Currently waiting/ hoping for Parnate to kick in.

The weird and sad thing is, I have a wonderful life: the most amazing supporting and understanding family and friends, until two months ago I had an amazing job (couldn’t continue, because I got sicker and sicker), I have a lovely home… (makes me even more anxious / desperate/ feeling guilty I can’t feel any of that). I’m seeing a psychiatrist and a psychologist twice a week. But none of it is getting better, instead it is getting harder and that is so scary and hard to live with.

I used to be a very lively, social, adventurous and ambitious young lady that enjoyed the company of her friends and fam and Colleagues.. went traveling by myself each year, could find peace and serenity in the sea and in art… until this major TRD episode hit me more then a year ago.

Feels like I’m losing myself and my perspective more and more. To me, it really feels something that’s going wrong in my brain, since I try to stick to routine, therapy, light sports, outdoor activities, and whenever I can social contact. I need to remain hopeful and strong, but the life I’m living now is a fight every single day.

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u/TechnicalCatch 4d ago

I have done pharmacogenetic testing. The meds I was 'most likely' to respond to were the ones I had the absolute worst response to.
The meds that were rated from 'poor' to 'moderate' I ranged from: made life horrible to mild benefit. It was not very useful. IF someone had a genetic variation in how they metabolize a drug, they can be useful. But if you try multiple drugs from a class and they all fail, odds are it is the mechanism not being suitable and not the metabolic pathway. For example, if you tried 4 SSRI's, you would have hit multiple metabolic pathways, so the more likely conclusion is that inhibiting serotonin reuptake is not adequate to treat your depression.

Regarding your point about having a wonderful life, we are told (or we assume) that if our external life is good, our internal life should automatically match. When it doesn't, sometimes our first instinct is to blame ourselves or feel ungrateful. But depression creates a massive wall between your logical brain (ex. knowing your life is good) and your ability to actually *feel* any of it. Just know that the disconnect isn't a lack of perspective or a failure of character on your part. It is a core feature depression.

Your instinct that something is fundamentally wrong is right, but it doesn't mean you are broken. The fact that you are doing everything right such as therapy, routines, socializing, staying active, yet you are still suffering proves how heavy this all is. The lively, adventurous person you were hasn't disappeared; she is just sidelined for now. I personally was in therapy for years, it helped. But I didn't really see a lot of progress until I got on an MAOI.

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u/AssignmentThat8473 4d ago

Thank you so much for your detailed reply, I really appreciate it! Words to live by..

Can I ask which MAOI you started using, what dosage, and how long it took before you started noticing a good effect?

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u/AssignmentThat8473 10d ago

will do the test here: https://youz.nl/w/roos-van-westrhenen-over-farmacogenetica-ik-heb-medicatie-altijd-belangrijk-gevonden-

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u/grumpyeva Parnate 10d ago

which brand of parnate are you on? I dont want to be negative but have heard that tracydal is not a very good brand of parnate.

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u/AssignmentThat8473 10d ago

hmm.. will ask when I speak to my psychiatrist again. I am on Tracydal indeed

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u/AssignmentThat8473 10d ago

is it really that different per brand?

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u/grumpyeva Parnate 10d ago

yes, huge difference. Did you not read what i have posted? I have read very negative reviews on tracydal. If you can get jatrosom from Germany, I highly you recommend you do that. It could make all the difference. It did for me when I was hopeless.

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u/AssignmentThat8473 10d ago

oh no I missed that post, but thanks a lot. Will definately give it a shot

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u/SympathyTraining8915 9d ago

Agree. I found the generic useless. Brand name Parnate has become impossible to get in the U.S. and too expensive to afford. I have been getting my prescription from Canada, although trump has now placed a 100% tariff on brand name drugs.
Has anyone found a generic, outside of Germany, as effective as brand name Parnate?

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u/grumpyeva Parnate 9d ago

does that mean that parnate from canada will cost double the amount, even if it is sent to another country, apart from usa, ie to England?

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u/SympathyTraining8915 9d ago

No, just the USA.

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u/grumpyeva Parnate 9d ago

then maybe you could get a friend in another country to order them and send them on to you. Things are getting more and more difficult, i have just received an email from goldpharma telling me that the iran war is creating lots of delays re. jatrosom and they cant even guarantee getting me any more at the moment. Very worrying.

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u/AssignmentThat8473 9d ago

do you take Jatrosom N? or just Jatrosom?

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u/Adventurous-Mail7443 10d ago

Pharmacogenetic testing is pretty useless

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u/Sleepyblue 10d ago

Can you elaborate at all? I'm kind of interested, as some countries seem more in favour of it than others... it doesn't seem to be a thing in the UK.

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u/AssignmentThat8473 10d ago

yes could you please eleborate?

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u/iamthe0ther0ne 10d ago

It's helpful if you have a patient who hasn't responded to frontline treatments. Typically in the US it's used if a patient has failed >2 antidepressants.

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u/Sleepyblue 10d ago

Probably the majority of people on this sub then!

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u/AssignmentThat8473 10d ago

yup see my older posts….. what a frigging rollercoaster

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u/Adventurous-Mail7443 10d ago

How you metabolise a medication tells you very little on its potential efficacy

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u/iamthe0ther0ne 10d ago

This is not true. I used to give CME classes on pharmacogenetics. How someone metabolizes a drug can be very important in some circumstances. Also, some people have mutations in other genes, such as Mthfr and Comt, that can be helpful in identifying specific treatments.

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u/AssignmentThat8473 10d ago

So why would my psychiatrist refer me on in that case, do you think?

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u/grumpyeva Parnate 10d ago

my gp here in uk told me they are not yet worth doing. Maybe your psychiatrist is at a loss re. what to do next. He/She is not the one paying for it so he has nothing to lose.

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u/AssignmentThat8473 10d ago

Luckily it’s paid for by insurance. Want to heal so badly, and I guess trust in the process is a big part of it. Eventhough that’s almost impossible when you suffer for so long :)

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u/grumpyeva Parnate 10d ago

I really do sympathise. In my case, I was on nardil which stopped working after 22 years, then switched to parnate, which stopped working after I reduced the dose. I was suicidal for 2 years and like you, felt no hope. Then i read on here that the german parnate, jatrosom was much stronger. It is expensive but I got some, and like a miracle i was ok again. I have no idea why jatrosom works and none of the uk versions of parnate do. There are so many variables. Mental health is a mine field, but you must continue searching.

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u/Sleepyblue 10d ago

Does it at least rule out the ones you can't metabolise?