BLOG No. TWENTY THREE

Welcome back to my blog on anxiety and depression. I have decided to share a few more case studies with you. I will not digress into further neurochemical discussion, but go directly to the story. Each of my cases is a little different, as I am trying to show the different faces of D2 dopamine.

“Amy” came to me after I helped a friend of hers with panic attacks. She had been given multiple SSRI’s to no avail (shocker I say, shocker!) to help her with her own panic attacks and obsessive/compulsive disorder. Though mild obsessions and compulsions can be serotonin deficiency driven, significant obsessions and compulsions belong to the family D2 dopamine disorders.

Amy came to me with obsessions and compulsions, panic attacks, and a different D2 issue that bothered her the most—derealization. Derealization is a bizarre feeling that your surroundings feel very odd—two dimensional at times, colorless at times, and distorted.

Time seems to be fleeting. Size and shape of objects tend to fluctuate. You can imagine how scary that would be.

Amy came into my office to discuss these issues, but found out a few days prior to her appointment that she was pregnant. Though we discussed medication that could be utilized in pregnancy, she decided to forgo them—feeling it was too much risk for the baby.

We stayed in touch during her pregnancy, the plan being to start medications after her delivery. And that’s exactly what happened. But the delivery of her baby and a hormonal crash after delivery, was incredibly destabilizing.

Amy would look at her baby and at times she didn’t recognize it as hers. Obviously she was devastated!

We decided together to start Lamictal and not do breast-feeding. Although I felt breast-feeding was important, the mother’s health was paramount. And Amy was ready to snap. We ramped up the medication until her blood levels were therapeutic. (Most labs say Lamictal levels should be 2-18 but for D2 issues, I use 6-18).

And Amy got better. But the derealization, the toughest symptoms to treat, was still haunting her to some degree. So I added low-dose Abilify and after adjusting the dosage once, her derealization was under perfect control. She saw her daughter for the first time as her daughter. She no longer saw the world in strange, contorted dimensions. To this day she stays in a good state of mental health. Her panic attacks are absent and her obsessions—other then for her beautiful daughter—are under control.

Well, I am trading in my empty Chardonnay glass for an Italian red wine to go with my cauliflower pizza, so it must be time to say goodbye. Until next time, when I discuss a fascinating case called PANDAS, this is Dr. G saying keep the faith!