BLOG No. THREE

Hi, this is Dr. G and welcome to my third blog on anxiety and depression. Last time we discussed how increased levels of type 2 dopamine (D2) caused racing thoughts, mood instability, anger and rage, obsessions and compulsions. We also saw how serotonin drugs (SSRI’s) can increase D2—not only failing to help depressed/anxious patients, but actually make things worse.

So, why do they do that?

I am going to resist what many mothers and fathers would say here—BECAUSE I SAID SO! I do that because there actually is a very good reason. And it stems from the two different theories of depression and anxiety that are currently postulated.

No. 1

The first theory of anxiety and depression is called the monoamine theory. It hypothesizes that depression and anxiety arise from a lack of serotonin and norepinephrine. These monoamines, the theory suggests are broken down too quickly by monoamine oxidase and thus are in short supply. So when SSRI’s like Prozac and Zoloft slow monoamine oxidase, serotonin and norepinephrine levels increase and Happy-land comes into view…well sort of. Yes, when elevation of these two monoamines occurs, simple depression and anxiety can lift—but only short-term anxiety and depression caused by burning the candle at both ends, personal loss, or other short-term issues.

No. 2

A second model better explains the anxiety and depression of people who have suffered more long-term issues. It is called the glutamic theory, a more modern postulate. Just as Einstein’s theories eclipsed that of Isaac Newton, the glutamic theory is overtaking that of the monoamine theory. But unfortunately, it has been slow to filter down to clinicians that cling to the old model. (You see how well that is working!)

The glutamic model states that glutamate (the ultimate brain exciter) and GABA (the ultimate brain relaxer) need to be in balance. But when glutamate overtakes GABA, D2 dopamine begins to climb, which increases anxiety, depression, and mood instability. This theory has been strongly bolstered by multiple studies showing how stressors raise glutamate, resulting in more anxiety, depression, and mood changes. I always tell my patients ENVIRONMENT MAGNIFIES GENETICS! In other words, when outside stressors—work, school, friends and family—start to exact their toll, glutamate overtakes GABA even more and the result is increased anxiety and depression.

How many doctors does it take to change a light bulb?

None, the light bulb doesn’t have insurance!

So why is all of this gobbledygook important?

Because how we treat anxiety and depression is critical to which of the two theories is more correct! And I will tell you, after 25 years of doing my own psychiatry, the glutamic model blows the monoamine theory away!

Whew! I’m glad that is all behind me. And I see that my cat has finished my Chardonnay and is walking funny, so I will say so long until next time when we begin to discuss medications. Keep the faith!

Until next time,