Quick Reference Cards

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Card 1 — Phenotype-to-Drug Map (PGx)

CYP2D6 — psychiatric prescribing

PM↑ TCAs, SSRIs (fluox/parox/venlafax/duloxet), antipsychotics. Codeine/tramadol → no analgesia. → 25–50% dose or alternative.
UMMost antidepressants subtherapeutic. Codeine/tramadol toxic. Avoid prodrugs.

CYP2C19 — citalopram / escitalopram

PMFDA ceiling: citalopram 20 mg, escitalopram 10 mg. QT risk.
UMSubtherapeutic — switch to sertraline.

HLA-B*15:02 — SJS

Positive17× SJS with lamotrigine. Black-box for carbamazepine in Asian-descent. Genotype before either.
RescueFamotidine + cetirizine BID × 10 d for early rash.

SLC6A4 — SSRI response

L(A)/L(A)10% — SSRIs likely to work.
L/S or S/S90% — SSRIs less effective. 2× PTSD/GAD risk if S/S.

HTR2A

A/A2.5× less likely to respond to ANY antidepressant. Use lithium / mood stabilizer.

COMT (stimulant response)

Val/Val (GG)62.5% likely to respond well to stimulants.
Met/Met (AA)Only 12% respond. Stimulants worsen anxiety / OCD.

BDNF

Met/MetAvoid SSRIs. Exercise + curcumin + lithium.
Val/MetMild ↓ working memory. Exercise critical.

DRD2

Del/DelAnhedonia, addiction risk. Bupropion or Auvelity.

Card 2 — Gates & Mood Stabilizer

ANK3 (Na⁺ gate)

T allele↑ mood-disorder risk. T/T = high BP risk. ‘Genius / fast brain.’
TxMood stabilizer first. Lithium uniquely targets both gates.

CACNA1C (Ca²⁺ gate, rs1006737)

A alleleAnxiety, BP, EMF sensitivity, suicidality on citalopram, 4× ECT.
TxMg threonate + lithium orotate. Avoid earbuds, off Wi-Fi at night.

Lithium Doses (Reed)

CognitiveLithium orotate 5–20 mg OTC.
Adult psychCarbonate 300 mg ER (cut half × 1–2 wk) → 450 → 600.
Pediatric150 mg short-acting bedtime; max 150 mg BID.
Bipolar600–900 mg.
AvoidLisinopril (renal co-excretion) — use losartan / valsartan / telmisartan.

Lithium Monitoring

TroughReed targets 0.2–0.3 (drawn 12 h post-dose).
LabsCMP / CBC w/diff / Li / TSH at 6 wk → 2× per year.
FormsOrotate 5% elemental; carbonate 18.8% (= 56 mg elemental in 300 mg).

Card 3 — Form-Matters Supplement Cheat Sheet

B-Vitamin Forms

B6P5P (NOT pyridoxine — neurotoxic in 0.8%).
Folate (MTHFR)L-methylfolate (Deplin). 2.5–15 mg.
Folate (MTHFD1L)FOLINIC acid, NOT methylfolate.
B12Methyl + adenosylcobalamin ≥1000 mcg/d.
B-complexNLite or Neuronutrients Mood Support.

Magnesium

Brain SxL-threonate (Magtein/Cognimag) — only BBB-crossing form.
Sleep / GIGlycinate or citrate.

Adaptogens (Stress / Cortisol)

Ashwagandha500 mg BID — 69% ↓ anxiety in trial.
L-Theanine50–100 mg BID — ↑ GABA-receptor activity.
LactiumSerenitin Plus (Douglas Labs) — milk peptide.

Histamine / Mast Cell

AOC1 / DAODAO enzyme (pig thymus, not kosher).
NPSR1Quercetin + Pycnogenol + Vit C + bromelain + melatonin pulses.

Antioxidants

GSTO1/2Vit C 1000 mg.
NQO1 ×2Ubiquinol (NOT CoQ10).
GCLCGlutathione spray + sulforaphane.

CNR1 Tri-Loop

DirectPEA, dark chocolate, EVOO.
EndogenousSinging, humming, running.

Card 4 — Reed’s Genetic Jobs

Border Collie

ADRA2A G + COMT normalHD with no AD. Fast brain. Theanine, magnesium.

Warrior

COMT Val/ValLow PFC dopamine. Stimulants likely effective. Tyrosine, methylated B.

Engineer

COMT Met/MetPerfectionism, OCD. Ashwagandha, Mg threonate, lithium.

Sweet & Sensitive

SLC6A4 SS or LG2× PTSD/GAD. Avoid SSRIs as first line. Validate them — they are nice to a fault.

Fearless

DRD2 deletionAnhedonia, addiction risk. Bupropion or Auvelity.

Creative Genius

CACNA1C single AMood lability. Lithium orotate, Mg threonate, EMF lifestyle.

Card 5 — Reed’s Treatment Algorithm

  1. Day 1: Full medical history. Order Genomind / IntellxxDNA. NO med changes yet.
  2. Week 3: Review test together. Start lithium 300 mg ER (cut half × 1–2 wk).
  3. 2–3 mo: Add lamotrigine OR L-methylfolate OR antidepressant. Confirm HLA-B negative before lamotrigine.
  4. Then: Remove offending drugs only after stable.
  5. Goal: Least medication, fewest problems.

Order of consideration

  1. Lithium (no PK pathway).
  2. Lamotrigine — ‘write the L’s’ (per Roger McIntyre).
  3. Antidepressant or L-methylfolate.
  4. ADHD: methylphenidate before amphetamines.
  5. Sleep: gabapentin > Lunesta or benzos.
  6. Anhedonic + DRD2 deletion: bupropion or Auvelity.
  7. Never: Depakote in childbearing-age women. Lisinopril + lithium. SSRIs in S/S.

Card 6 — Hausman-Cohen’s ‘Fundamentals’

Inflammation

TNF-α, IL-1α/β, IL-6, FCR1A (mast cell), NLRP3 (inflammasome), CCL2/CXCL8.
Tx: Curcumin, Pycnogenol, Boswellia, omega-3, fisetin (strawberries).

Detox / Oxidative Stress

GCLC, GSTO1/2, NQO1, PON1.
Tx: Glutathione, sulforaphane, NAC, vit C, ubiquinol.

Nutrients

MTHFR, MTRR, FGFR2/MUC1 (Mg), PPDC (Zn), ALDH (B6 P5P), MUT (B12).
Tx: Methyl B-complex with P5P, Mg threonate, zinc, methylcobalamin.

Gut

AOC1 (histamine), HLA-DQ2.5 (gluten 7×), CTLA4 (autoimmune brake).
Tx: 2-month strict gluten-free trial; DAO enzyme; low-histamine; SIBO workup if indicated.

— PsychGenomics Quick Reference · This is an educational aid. Validate every recommendation against current CPIC, FDA, and DPWG guidelines. Use clinical judgment.