BLOG No. TWO

Welcome back to Dr. G's blog on anxiety and depression. In my first blog, I opined that

(1) family doctors know little about how to treat anxiety and depression

(2) psychiatrists don’t know that much more, unfortunately

(3) a lot of counselors play the blame game (it’s your mother’s fault)

...when in fact, anxiety and depression are mostly genetic.

Today, I will begin discussing the genetics of depression.

Depression and anxiety are caused by either a lack of serotonin, an excessive amount of type 2 dopamine, (there are 5 types), or most commonly, a mixture of both. Most clinicians only understand the low levels of serotonin. And when you are a hammer—everything looks like a nail. The problem of treating these conditions with serotonin meds is that although you raise serotonin, the SSRI’s raise levels of D2 dopamine higher. In other words, it makes the patient both better AND worse! Sound familiar?

Pure serotonin conditions are the chief cause of anxiety and depression less than half the time. Traditionally, they occur when a patient has a significant loss in his/her life. An example would be losing a great job, a significant other, or a cherished family member. The patient goes into a bit of a funk. And when they can’t pull themselves out, an SSRI usually will lift them out of their funk.

But when depression and anxiety are more long term, not just brought on by a loss, it probably has a component of D2 dopamine elevation. And as mentioned above, pure SSRI treatment raises the serotonin, but also ramps the dopamine even higher—causing the patient to be better AND worse.

What do you call anxious pasta? SPAZghetti!

So, what are the symptoms of high D2 dopamine?

(1) being quick to anger or emotion

(2) rapid mood changes

(3) racing thoughts

(4) having trouble shutting your brain down, especially at night

(5) obsessions or compulsions

(6) paranoia

(7) bumping heads with friends, family, and coworkers.

Not all 7 symptoms usually occur in the same person. But a patient with dopamine issues probably will have at least 3-4 of these. And another big red flag that says someone’s chemistry is heavy in D2 dopamine chemistry is a patient who has not responded well or who has had side effects to one of the SSRI’s.

Also, if any blood relatives have a history of suicidal ideation, abused alcohol, or have been hospitalized for mental breakdowns, this could indicate more of a D2 type chemistry.

Now does every patient with an elevated D2 chemistry need treatment? Of course not. Just as a newly diagnosed diabetic might be managed by diet alone, anxiety and depression can sometimes be managed without putting greenbacks down the proverbial G-string of pharmaceutical companies.

Meditation, yoga, stress management, and other non-drug modalities are reasonable to try if the condition is not negatively affecting a patient’s life. But if it is affecting life, work, relationships, school, etc. perhaps treatment would be helpful.

Well, my cat and dog have both fallen asleep reading this, so maybe it is time to put down the electronic hammer and chisel and say so long. But tune in next time where we will continue to discuss the role of dopamine in depression and anxiety. Until then, keep the faith!

Until next time,