BLOG No. SEVEN

Welcome back to blog number seven of my series devoted to anxiety and depression. We have learned that anxiety and depression are hard to treat using traditional methods using serotonin and norepinephrine, because of a chemical called type D2 dopamine. When D2 it Is elevated, mood is destabilized.

All of the serotonin in the world is not going to fix it.

But up until now, we have relied on my word, based on my years of clinical experience. But what if I am just a lying, narcissistic, ass wanting my name in lights? I am pretty sure that I am not, however, let me share with you a huge, clinical trial, that was performed in the United States from 2001 to 2006 that might clear my name.

It was called the STAR-D trial, and it was done to prove the original theory, at the time, that stated that unipolar depression could be treated systematically with serotonin and norepinephrine medications, and the majority of patients would get better. (LOL)

All the depressed patients in this trial were placed on Celexa, a popular SSRI that came from Europe. In the initial arm of the trial, about 28% of patients responded to the point of being in remission after 14 weeks. Of the 72% that failed, these patients were able to either add a medicine to the Celexa, or switch entirely to serotonin drugs that also increased norepinephrine. Less than 20% of those patients were successful.

Then, all of those patients that were still depressed, and hadn’t dropped out (many did) were offered a third choice—either adding lithium, an old antidepressant or are adding T3, a thyroid medicine known to help depressed patients.

A third alternative was another medicine, called a tricyclic (TCA), that raised serotonin and norepinephrine. In the trial, a few more people improved, but the vast majority didn’t, and they went onto the last and fourth step, where are they were offered more serotonin and more norepinephrine combinations. Very few got better. Though the creators of the study at the time thought that they had the perfect algorithm for fixing depression and anxiety, truth be told, most patients did not get better.

So what did we learn from this?

Well, once a patient fails an SSRI over several weeks, the odds of more serotonin and norepinephrine combinations don’t really help much. (Surprise, surprise! Sound familiar?) Hummmmm…I wonder what we are missing. What possibly could it be?

So fast-forward to 2008. Eli Lilly and company (a pharmaceutical firm) decided to do their own version of STAR-D. But instead of using Celexa as a beginning point, they used Prozac (they created that SSRI and had a full supply of it). Stages one and two were nearly identical to the first STAR-D with Celexa. But when they got to stage III, with the majority of patients still failing to achieve remission, they moved patients to a combination of Prozac and Zyprexa ( a suppressor of D2 Dopamine).

All of a sudden, the results went through the roof! The 20% responders, after their original Prozac, jumped to 86%! So perhaps, I am not the lying, narcissistic, douche you perhaps thought I might be. (Okay, I still may be a little bit of a douche lol.)

So why am I dragging you through this?

I did it to prove the importance of D2 dopamine elevation. And remember, these trials of STAR-D excluded any form of bipolar disorder, the ultimate of D2 dopamine elevation. So the conclusion is that even if you are not bipolar, which most of you will not be, much of your anxiety and depression are probably from D2 dopamine elevation.

Well, that Chardonnay in my glass is beginning to taste a little bit like urine…and my urine sample at my doctors office came back as inconsistent with human urine. Hmmm, can’t believe that is the second time this has happened! Tune in next time, when we discuss "cutters, burners, and pluckers."

Until then, keep the faith!