BLOG No. THIRTY FIVE

Welcome back to my blog on anxiety and depression. Today I want to discuss a case study of depersonalization and derealization. You remember from the previous blog that depersonalization is when a patient loses touch with their own emotions, or they see themselves physically different from what the rest of the world sees. They can look at their hands or feet and they might appear elongated or short and fat, even when a photograph would show otherwise.

Derealization is a similar feeling but it is a distortion of the outside world. The reality around the patient just does not feel real. It can be just two-dimensional, where something just does not appear in the way that it physically is. Together, I call these conditions D and D, to save a lot of typing. So if enough of the intro, let’s get to a patient case.

A patient whom I helped with her anxiety and depression referred a good friend of hers, who was also suffering with anxiety and depression along with D and D. She tolerated the anxiety and depression for a long time, but when the D and D became too much for her, she came and saw me. We talked about her anxiety and depression along with the D and D at her very first visit. But just before she was able to start her medicine she found out that she was pregnant. I didn’t hear from her for nine months, but after delivery she came back to see me.

Just as delivery of a baby can bring on postpartum depression, it pushed her D and D to the maximum. I vividly remember her face, terribly frightened by the D and D. She told me that that time she would look at her baby and think that it wasn’t hers. She also said that the shapes of the world changed frequently, sometimes lasting four hours—with objects looking taller than they actually were, and sometimes the world appeared as two dimensions.

She asked tearfully if I thought she was crazy. Of course if I told her no. Congress, yes— her, no.

Reality check. A man was having dinner with his wife when she notices that he is been staring at the same drunk woman all evening, sloshing down one gin and tonic after another. She finally asks, “Do you know her?”

“Yes,” he answers. “That is my ex. The word on the street says she hasn’t been sober for the seven years since we divorced”.

The wife relies, “Who knew she would want to celebrate that long?”

And as if the D and D were not bad enough, she also suffered from OCD and the anxiety and depression. But the big question that she harbored was:

why did the birth of her baby make everything incredibly worse?

Well, remember blog 28? The birth of a baby is a hormonal shock. And we’ve also learned that shocks to the body, be an emotional or physical, can magnify a person’s genes. My patient was already having a lot of D2 dopamine issues when she became pregnant. But when the estrogen elevator crashed after delivery, the D2 dopamine flew up like a counterweight. Racing thoughts ensued, until her brain ran so fast that is actually altered her perception of reality.

So what type of medicine do you think I put her on? If after all these blogs you said serotonin, rename yourself Sparky and go play with electricity. I put her on Lamictal, which worked extremely well. The only anxiety she experiences now, comes from her three year-old toddler.

Well, it’s so hot today, I think my Chardonnay must have evaporated! I mean, what else could’ve possibly happened? Until next time when I take up the subject of anorexia nervosa and bulimia, this is Dr. G saying, keep the faith!