BLOG No. FOUR

Welcome back to Dr. G’s fourth blog on anxiety and depression. We have learned in previous blogs that most clinicians, though they may try, aren’t much help in treating chronic anxiety and depression. And we have learned that type 2 dopamine (D2) is responsible for a lot of anxiety, depression, and mood instability.

And we also learned that there are two theories regarding the source of anxiety and depression. First, there is the old monamine theory, where deficiencies in the chemical serotonin cause most of the suffering. Most clinicians still cling to this theory like an ancient religion, which make them ineffective. Second, we spoke of the glutamic theory, which is a much better explanation of anxiety and depression. Here, the ultimate brain exciter (glutamate) is paired up against the ultimate brain relaxer (GABA). When in balance, all of the other neurotransmitters, like serotonin and dopamine are in harmony and the brain functions well. (Can anybody say yin-yang?)

Balance in the body is critical!

Whether it is hemoglobin—the iron carrying molecule, pH—the acid base balance, or your electrolytes, like potassium, which if too high or too low could stop your heart. Why would balance be any less important for your brain?

So, how do we balance out the yin-yang of glutamate and GABA?

Actually, it is not that difficult. One of the best ways is to utilize one of a handful of seizure drugs. Yes, you heard that right, seizure drugs. But seizure drugs have many uses. Doctors use them to prevent migraines, help with neuropathies, and now, smart doctors use them for anxiety and depression that are driven by imbalances in glutamate and GABA. I like to use the word, homeostasis, to define a balance of critical reactions in the body.

Just as the air and gasoline balance in a fuel injector makes an engine purr, so the balance of glutamate and GABA make the brain purr.

When the balance of chemicals in the brain is achieved, it fires on all cylinders, evicting anxiety and depression, welcoming normalcy and a calm brain. Wouldn’t it be nice to wake up to a brain that felt like a Caribbean breeze instead of a mental tsunami?

So, what are these medicines to help balance the brain?

My favorite medicines are Lamictal (lamictogene) and Trileptal (oxycarbamezapine). Another favorite is Depakote (valproic acid). Although each of these has their own side effects, Lamictal and Trileptal are extremely clean. Depakote is a little stronger, however the patient needs to watch for weight gain. (I see this more in females than males). Both Lamictal and Trileptal are weight neutral (no weight gain), have no sexual side effects, and like a lot of drugs, are ramped up over periods of time. This is to prevent side effects such as rashes and dizziness, etc. I would say that both of these medicines work 98% of the time with only 2% of patients stopping for various reasons.

When these medications develop a proper blood level, homeostasis is achieved between GABA and glutamate. Then, all of the other neurotransmitters, including type 2 dopamine—responsible for mood swings and anxiety—fall into balance. At that moment, anxiety and depression fade away, emotions normalize, sleep returns, and patients return to normalcy—though many of my patients admit that they don’t quite remember what normal feels like.

But listen, you deserve to feel normal.

Okay, the Ohio Liquor Control just came in, frowned at me, and walked away with my Chardonnay. They were saying something about some back taxes. So until next time, where we discuss more medications, this is Dr. G saying-

keep the faith!