you have similar issues as me. The main manifestation of my illness was OCD, panic depression etc. along with fatigue.
I don't agree with your practitioner on folic acid. Given your SNPs (single nucleotide polymorphisms) I would avoid folic acid. I don't know if you need to take methyl-folate though as you don't have a lot of issues on your MTHFR gene but you have a couple SNPs which means folic acid will cause you problems especially around serotonin synthesis so if I were you I would stop taking that.
An important point to make here is that there are several molecules that constitute forms of B9 or folate. There is folic acid which is synthetic and not helpful for people like us. There's folinic acid which some people have more success with but I can't take it. I use L-5-methylfolate which is the methylated natural form but my MTHFR gene is in bad shape and yours isn't that bad.
I would also look to start reducing hydroxocobalamin because of your MTR and MTRR SNPs I would be taking methyl b12 methylcobalamin but this will cause you some suffering as you heal and detox as it is a methyl donor and will definitely increase methylation and neurotransmitter synthesis. So go low and slow with methylcobalamin.
I used hydroxocobalamin with lots of success in the beginning as I dealt with start up and detox symptoms. It will give you some b12 without adding methyl groups but eventually you'll max out your healing with hydroxocobalamin as it will put the brakes on methylation so I don't use that one at all anymore. I only use methylcobalamin and adenosylcobalamin now.
The problem here is that you have numerous SNPS on your COMT gene like me which means that you will be sensitive to methyl donors and WILL have anxiety as you heal etc. The COMT gene is the main source of your anxiety because you won't break down dopamine, adrenaline or noradrenaline fast enough and these will build up in your brain causing anxiety.
The key to getting this enzyme and gene working is to make sure your SAMe to SAH ratio stays high as this will stimulate flow through the enzyme but supplementing SAMe never worked for me. SAMe in supplement form always caused me to have panic attacks so I accomplish this by making sure the rest of my methylation is running optimally.
Also, because of your COMT you may have estrogen dominance. I used a supplement from AOR called Estro Adapt but the active ingredients are calcium-d-glucarate and DIM (diindolylmethane). These are potent liver detox agents and will help lower your estrogen and detox pseudo estrogens.
In addition, b vitamins work in a system and you'll need to supplement them all so they'll work. In particular, b2 is very important for b12 to work as is b6. Vitamin b6 is also indicated by your CBS SNP. Inositol and nicotinic acid (niacin) are also B-vitamins that can help with anxiety but niacin can hamper your methylation
Your Gene report isn't that helpful to be honest the way it's written. If you have your raw data, I would look into https://www.nutrahacker.com/
. They provide much better reports.
One gene you'll want to look at is the GAD1 gene as it can be a real driver of anxiety due to glutamate overload. Glutamate is the most excitatory neurotransmitter and will cause OCD and panic as well.
I have had to attack my diet with vigor. Here's my advice for you, stop gluten and dairy immediately they are direct contributors to anxiety. My anxiety was cut by more than half when I stopped eating those foods. Gluten and Casein can cause your body to build up glutamate and adrenaline. I use only organic coconut and olive oil for cooking and I make sure I get lots of high quality salt. I use Redmond Real salt, this helps to make sure we're getting all of our trace mineral elements as these are essential to proper enzymatic function.
Word of warning, if you are gluten sensitive, and you eliminate from your diet, you'll become even more sensitive to it. I'm at the point now where even trace level cross contamination will cause me problems but overall going gluten free was a revelation.
I would also look into your oxalate status as this was a major driver of anxiety and depression for me.
I eat a grain free, sugar free, alcohol free, dairy free, nut free, low oxalate, low salicylate strict ketogenic paleo diet. I eat mainly high quality meat (no processed meat), low oxalate vegetables and some fruit but I try to stay ketogenic as much as possible as this really lowers my anxiety and improves my fatigue. This will help you as you have problems around detoxification.
You'll also want to make sure you get sufficient omega 3's (fish oil) to help with neurological healing and your depression.
I would also look into your thyroid and iodine supplementation. Iodine can help with anxiety especially if it's related to hypothyroidism.
Also molybdenum is something I've had a lot of success with. I would check my sulfite status to see if this is necessary. With your history of smoking, you'll want to make sure you get your glutathione synthesis running. If you have sulfite overload this may prevent glutathione synthesis and you might need molybdenum. You have a SNP on your CBS gene but it's not an upregulation so you might not have a sulfite issue but I would check. Sulfites can drive anxiety as well.
Another word of warning, cadmium detox is pure hell. I was also a smoker and a user of cannabis so I know what I'm talking about. Cadmium toxicity is also closely related to aluminum and copper toxicity so I would look into getting a hair mineral test to get some insight here. Detoxing copper, cadmium and aluminum is brutal for anxiety but absolutely necessary to get back to health.
Magnesium malate is great for aluminum toxicity and molybdenum is great for copper toxicity.
Molybdenum and iodine along with b2 are essential for proper b12 function.
I have also used the following supplements with success to help with anxiety: lithium orotate 5mg (this stuff has been a godsend and is excellent for OCD and anxiety), kava kava (very effective for glutamate based anxiety, it takes a few weeks to start working due to reverse tolerance), tryptophan and 5-htp along withy b6 for serotonin synthesis, Lemon balm (Melissa) this one worked well.
I know that the SLC gene SNP can be very impactful but I don't have that one so you'll have to research that one on your own but you should consider zinc supplementation as this will also give you some indication as to your copper and cadmium status.
Hope this helps.