BLOG No. FORTY THREE

Welcome back to my blog on anxiety and depression. As promised, today I want to talk about post-traumatic stress disorder (PTSD). As you are probably aware, PTSD is an abnormal response to a normal stimuli (my definition). For instance, a group of friends walking down the street hear a local car backfire. A few in the group gasp, then chuckle after they see smoke come from a tailpipe. But one of the group dives for cover and begs his friends to hide with him. After 20 minutes of cajoling , the young man comes out of hiding, shaking and almost in tears. An hour or so later he finally returns to his jovial self.

It is still uncertain why PTSD happens. We know women are twice as likely to have PTSD, but we don’t know the reason. But according to the NCBI, we do know a little bit about the neurochemistry. For instance, we know glutamate is stimulated in PTSD. Do you remember glutamate…the ultimate brain stimulator? And we know that GABA (brain relaxer) binding sites are diminished in PTSD, which results in less GABA stimulation. Let’s see, increased glutamate and decreased GABA… that ought to be a big clue. But before we go deeper come on let’s have a joke break.

A lion walks into a bar and goes up to the bartender. “I would like to see if you have a job opening.” The bartender looks back at the lion.

“Unfortunately, I do not have a job for you. But have you tried the Circus?”

The lion looks perplexed back at the bartender.

“What would the circus want with a bartender?”

There are classically three domains of reaction to a troubling stimulus in PTSD. 1) Reminders of the exposure (flashbacks, nightmares, etc.). 2) Activation-ramping up (hyper-arousal, insomnia, impulsivity, irritability, anger). 3) Deactivation-shutting down (numbness, derealization, depression, depersonalization).

Hummmm. Intrusive thoughts, insomnia, impulsivity, irritability, anger, depersonalization and derealization… have we seen these before? Oprah? I don’t think so. My blogs are riddled with these words. Then add what we learned about glutamate simulation in PTSD and the lack of GABA stimulation. Are we on to something? Does that sound like D2 dopamine? (Just nod your head like a good little student).

Of course it does. And I have treated numerous patients suffering from PTSD with Lamictal, Trileptal and/or a direct D2 dopamine suppressor. There is a serotonin element to PTSD that can’t be ignored, though small. Therefore sometimes I add a low-dose SSRI. I have been fortunate to have a tremendous success in the group that I have treated, so I truly believe that PTSD is a D2 dopamine thing, driven by glutamate and GABA imbalance. If you have a friend or family member suffering from PTSD, please share this blog with them.

So my robot just asked me if I wanted another glass of Soquel Chardonnay. I answered “Soquel me, Soquel me!” Then it pulled out a gun. So until next time, this is Dr. G saying keep the faith!