BLOG No. TWELVE

Welcome back to blog number 12 of my series on anxiety and depression. We have talked about the frustration many people feel when trying to get help with their anxiety and depression, due to an incomplete diagnosis. So many patients that I encounter have both serotonin and dopamine (D2) components to their anxiety and depression, but are only being treated for the serotonin.

So what are symptoms of a serotonin deficiency and how do they compare with those of D2 dopamine excess?

Well, to be honest, a few of the symptoms overlap both. Perhaps that is the reason misdiagnosis occurs. But to help sort it out, let me first start off by saying that serotonin symptoms are milder—milder anxiety such as social anxiety and milder depression symptoms. Pure serotonin depression (unipolar) patients, rarely commit suicide. though they may make incomplete attempts as a plea for help.

Pure serotonin patients with anxiety and depression are also less likely to self medicate, short of a beer with the boys or a glass of wine or two with dinner. A few may imbibe a little more, but it tends to be more social drinking, or drinks they enjoy. (My cat has a hankering for evaporated milk martinis with a catnip garnish). But the alcohol consumption is not typically used to drive down D2 dopamine, as that is unnecessary. Thus, alcoholism in the family can tend to make me think that relative of the drinker might have more of a dopamine chemistry (D2).

But I do find a lot of my anxiety and depression patients do have D2 symptoms, such as anger issues, racing thoughts, obsessions and compulsions, wider swings in mood, insomnia, and more severe panic attacks. Sound familiar? Understand, one person may not have all of these symptoms, but may exhibit a few of them.

And when excessive D2 symptoms exist, of course SSRI’s won’t relieve them—and frequently can make them worse. So by adding D2 meds that suppress the dopamine, the symptoms disappear. And once the D2 symptoms go away, it is then easier to adjust the SSRI (if they are on one). Patients frequently can lower the dose, which can bring fewer side effects. Or perhaps, when the mood becomes stable, and the patient is still in a bit of a funk, the dose can be safely raised. In some cases, the SSRI couldn’t be raised previously without aggravating the D2 levels.

A bit confused? Think of it this way:

Serotonin drugs are the gas pedal of the brain.

D2 medications are the steering wheel. Would you ever pull out onto a street and hit the gas, without having a good grip on the steering wheel? Of course not. So once the steering wheel has been stabilized, it is then safe to hit the gas.

Of course, the other way of doing this besides the direct D2 meds such as Abilify or Vraylar, is to add the indirect mood stabilizers such as Lamictal or Trileptal. Depakote is a little stronger, but you need to watch for weight gain. (I also tend to use these meds in migraine sufferers, as they are great anti-headache meds). Either way, direct of indirect, the steering wheel is controlled, stabilizing the patient.

Well, I just figured out that what I thought was Chardonnay is actually olive oil. That explains why my omelet burned this morning. Well, until next time when I discuss “Why can’t I have my Xanax”, this is Dr. G saying, keep the faith!