Help with COMT/MAO-A and SSRI

[bjberglund]

My 11 y/o son is homozygous for COMT V158M and H62H, MAO-A and MTRR. He is heterozygous for MTHFR C677T, A1298C, AHCY-01, 19 and CBS C699T/A360A. He is having tons of problems with depression, mood, anxiety, etc. He refused to go to school 4 days last week. He also has Lyme and Pandas. We are working with a functional medicine dr and put him on Prozac last week but now I'm reading that an SSRI with his COMT mutations may not be the right way to go….that maybe an SNRI is a better option. After 3 days on the Prozac he seems more irritable than before. Can anyone help?

[searching_for_help]

Is he on methylfolate for his MTHFR mutations? Our dd is hetereo for both, also. Due to my concern with her not utilizing her supplements due to a crappy gut, I supplement with a sublingual methylfolate/methylB12 combo through Methyl-Life, in addition to a methylfolate capsule. (Since I'm not sure how much she needs, I'm alternating 5mg and 10mg. The sublingual is low dose.) Everyone has different ideas on dosages. Her testing showed she's about in the correct range for that.

 

We also have MAO+. Yasko suggests several things for that- we use Feverfew. Really couldn't tell you if it's helping or not.

 

What is his VDR Taq status? Yasko suggests different things for COMT depending on the VDR Taq status.

 

Our neurotransmitters can get really screwed up if we have gut problems, which can be caused by antibiotics (among other things.) I'm assuming he's been on abx for Lyme or PANDAS - is he taking probiotics?

 

We tried different drugs from different classes to no avail. I had no idea how much the mind is connected with the gut. We had the Organic Oats Test run through Great Plains Lab, and our dd has yeast and clostridia overgrowth we are working on now, with specific probiotics and Nystatin and Diflucan. The interpretation on the lab test talked about how the elevated HPHPA (clostridia - not c. diff) could affect her neurotransmitters (she's very high in dopamine and low in epinephrine.) We have noticed her mood has been much better this past week. This is NOT to say her other problems are gone - but it's a step in the right direction.

 

I'd also check B12 levels. It's amazing the wide variety of physical and mental health problems can be helped by B12.

[LNN]

This thread (#18) outlines what I did to sort it all out http://latitudes.org/forums/index.php?showtopic=3928&page=2 - pick up from #5. I really found the heartfixer doc listed in this link to be the best, "simplest" guideline. Yasko - for me - was difficult. She recommends so many supplements, including the RNA formulas that don't have any research proving their effectiveness.

 

As Seeking says, you also need to consider the VDR status before you can make a decision on COMT. But I'd hesitate on the SSRI and also on an SNRI. Both COMT and MAO-A downregulate the rate at which your body degrades serotonin - which is also what an SSRI also does, in a somewhat different way. So you may be "flooding the carburetor" with serotonin. Instead, you can read the heartfixer doc to get an idea of what blend of methylfolate, some form of B12, vitamin D and other Bs to use. Keep some small doses of niacin or niacinamide on hand for bed temper days. 50mg of niacinamide calms my kids greatly - but my DD (an undermethylator with MTHFR, COMT, VDR, CBS and MTR/MTRR issues) can only tolerate niacinamide greater than 10mg during a meltdown. Otherwise, it sucks up too many methyl groups for her.

 

Do yourself a big favor and only address one gene at a time. Yasko says start with CBS for 4-6 weeks. But then I'd move to MTHFR for at least 4 weeks - maybe longer until you're sure you've got the dose and frequency right (my DD only needs 67mcg of methylfolate 3x/wk - you don't need much to see a big change sometimes). Then address COMT/VDR, then use phosphatidyleserine for MTRR if ADHD is an issue. Then for MAO-A, check copper/zinc levels and consider supplementing with 2mg copper daily. Copper upregulates MAO-A.

 

FWIW - my DS also had lyme and Pandas, along with pyroluria and a mold sensitivity.Treating methylation certainly helped, but getting on top of lyme was really our turning point and unfortunately, some days just required pushing through.

[pr40]

your child's mutations sound like what we have. I found all the mutations just too complicated to deal with. I did discover the following, SSRIs did not help but made us/me anxious. Molybdenum, charcoal work well for cleansing, Yucca every other day or so, Soy Lacetin,

5-htp when needed in place of SSRI -- try a small does and see if it has effect.

we stay of b12 since no one in my family can process it well - initial reaction is great but it does not last and kids become loony.

by the way, if your son has all these mutations, one of you parents has something quite similar. I try everything on myself first. Then try to adjust it for their mutations.

we do olive leaf, fish oil, ibuprofen, cq10, abx and not much more. gluten and casin free diet plus not much sulfur foods.

i would be curious to hear what helped you. when you figure that out, please post

[ssklr]

Wow, so don't know how things are going now, but I'll add my two cents. According to Dr. Ben Lynch, high-dose niacin can be good for people with serotonin issues (depression, etc.). Now, I realize niacin is a methyl mop, but I think it is about finding a balance. With COMT, you don't want to be over methylated. It can cause depression, irritability & anger. I've seen this in my son, who is COMT, MTRR, MTHFR, amd some others. He was on 5000mcg methylcobalomin daily. We switched him to hydroxycobalamin (the body can convert it to whatever form it needs + it doesn't have methyl groups). It was like night & day. He became happy and more compliant. It may be that your son needs to be on high-dose niacin & high doses oh hydroxycobalamin to address seritonin & MTRR. Hydroxy allows you to use other methyl-containng supplements like methlyfolate. There are other supps that are methyl donors. I think you need to get the right balance of niacin & methyl groups. Inthink the niacin will mostly mop up only excess methyl groups. Check out what Dr. Ben has to say about it. Some People have tried it with good results. And when I say high dose, I think he recommends 500mg niacin daily for adults. Don't know about kids.

[AnnaBelle]

Hi...just joined your forum and found this old post. Perhaps...perhaps...this person who made this comment can elaborate such as where I can find Yasko's suggestions for COMT. I specifically want to know how to speed up or increase the activity of this enzyme in order to lower my slightly elevated norepinephrine levels which labs have verified and testing showed I have C/T(C677T) and A/C (A1298C) genotype. If not, surely someone else can provide this info.

 

Please excuse my ignorance. Am new to this world of MTHFR. Dr tested for MTHRF...used a much more simplified test than the 23andMe testing.

 

TIA,

 

AnnaBelle

 

What is his VDR Taq status? Yasko suggests different things for COMT depending on the VDR Taq status.

[LNN]

This is the best summarized advice on Yasko's work and how to deal with each snp. http://www.heartfixer.com/AMRI-Nutrigenomics.htm

But you need to know the status of all the genes in theses cycles, not just MTHFR. You're assuming (I gather) that you have issues with COMT because you have elevated norepinephrine. But COMT is not the only gene that regulates this neurotransmitter. The body always has fail safe redundancy and MAO-A is at least on other gene that regulates norepinephrine levels. I made the mistake of assuming things about myself while I waited for my 23andMe results and I ended up taking the wrong things. I highly recommend you do 23andMe to get the full picture.