BLOG No. ELEVEN

Welcome back to blog number 11 on anxiety and depression. I had promised to reveal my favorite chardonnay in blog 10, but completely forgot. And my editor and web-master evidently loves tequila shots as much as I love chardonnay, as she forgot to remind me. (Just kidding, Lauren!) Although there are a lot of wonderful white wines out there, Rombauer chardonnay is my fav! It will set you back about 40 bucks, but worth it I think. (Lauren, has the wine endorsement check come in yet?)

Anyway, best to get back to blogging. In previous blogs we discussed the many psychiatric conditions as points on a spectrum, with serotonin conditions (unipolar) to the far left, and D2 dopamine conditions (bipolar) to the right. If you are reading this blog, looking for answers to your anxiety and depression, I would surmise that you are not a unipolar patient. Why would I say this? Because any SSRI doled out to you from your clinician would have probably worked by now. And you wouldn’t be looking for answers.

And if you have a form of bipolar disease, I would have hoped by now you would have been properly diagnosed and were receiving appropriate medicine. But even if you haven’t been properly diagnosed, I am sure my future blogs on the various diseases will help.

But I will go out on a limb here and predict that most of my readers looking for help with their anxiety and depression don’t fit pure unipolar or bipolar molds. So if you are not either of these, what might be the right diagnosis for you? What else is there besides the polar opposites? Let’s go back to our continuum/spectrum and take a look-see.

So, what the hell is what the hell? Some clinicians call it a mixed state, though there is no clinically accepted term. I call it no man’s land. But call it what you want, Bob or Mary Ann, what is important is the chemistry!

The mixed state is exactly as it describes—a mixture of serotonin symptoms and D2 dopamine symptoms. Yes, SSRI’s help the serotonin symptoms such as mild social anxiety or a bit of a depressive funk, but as previously mentioned, can aggravate the D2 symptoms such as anger, insomnia, racing thoughts and the like. So the patient in the mixed state, on only an SSRI, can feel both better and worse. Sound familiar?

And mixed state patients frequently get switched from one SSRI to another, looking for Holy Grail of medications. Does that also sound familiar? If you puke up Coke, Pepsi, and Mountain Dew, do you really think Dr. Pepper is going to stay down? If you have failed Paxil, Effexor, and Prozac, do you really think Lexapro is going to be the magic pill that controls your anxiety and depression?

What happens when you leave your ADD meds in your Ford Fiesta? It becomes a Ford Focus!

So how do we treat people who are in the mixed state? Here is how I do it. If a patient is already on an SSRI and tolerating it just fine, I will either add a low-dose D2 medication, such as Abilify or Vraylar, or a GABA/Glutamate balancer, such as Lamictal or Trileptal. (I will be discussing individual drugs in future blogs.) But once either medication controls the excessive D2, the patient returns to normalcy.

That means anxiety and depression are well controlled, and the patient has normal, reasonable emotions. Sound good?

Well, my cat has once again got her tail stuck in an empty chardonnay bottle. ARF! ARF! Sorry Fido. Well, until next time—where I will continue the discussion of mixed state.

Keep the faith!