BLOG No. SEVENTEEN

Welcome back to my 17th blog on anxiety and depression. Yes, I am still in Cabo, and my new friend, the 87-year-old man who doesn’t believe in anxiety and depression, tells me this is his last trip to our mutual timeshare. He is giving the next seven years of his 30-year commitment to his kids. He doesn’t bring up anxiety and depression. He only sips on his Jack and Coke and intermittently rubs his arthritic knees.

I have decided to devote the next handful of blogs to some interesting cases. My first case we’ll discuss “Mary” (name changed) a 66-year-old lady who has been in my practice for several years. Her and her husband, like a lot of older folks, live on a fixed income. Money has never been taken for granted. One year, just after Christmas she decided it was time for a new winter coat. Ohio winters can be brutal, and the January wind can cut through an old tattered coat.

She saved up her money and headed out one morning, excited to try on coats from an Ohio, chain store known for bargains. As she moved from one coat to another, she felt almost giddy at the prospect of a new winter garment—giddy that is, until she didn’t see her purse.

Panic set in.

When the quick search came up empty, she thought that she might have left her purse in her unlocked car. She bolted, as fast as a 66-year-old lady could, out of the doors towards her car. But when the alarm sounded, she realized that she had on one of the coats that belonged to the department store. And sure enough, a local Township policeman just happened to be driving by at that moment.

An hour later, she found herself downtown at the police station, a young, overzealous policeman berating her for a confession. Her husband could hear her crying, as the cop relentlessly questioned her. She finally relented to his aggressive interrogation, just to get out of the police station. A couple of days later she arrived in my office in full panic mode. She was crying so hard, I had a hard time understanding her. I explained that she was having a situational anxiety, and prescribed a handful of Xanax. But two days later she was back in my office significantly worse. Her mind was racing, her anxiety was unhinged, and she has severe insomnia.

She was melting down right in front of me.

Although she denied any history of anxiety or depression, she suddenly had been thrust into near mania. For a moment, I was puzzled. And her devoted husband was insistent that I help her. When I probed her family history, I found out that her grandmother had suffered from manic-depression, the old term for bipolar disorder. I put her on a strong D2 lowering medication called olanzapine. In two days she was 50% better. I doubled dose and she returned back to her normal self.

I tell the story to illustrate how something called “the new genetics” works. The gene for mood disorders can lie dormant. And then, a stressor—be it physical or mental—can awaken that gene. That’s what happened with Mary. And to bring closure to the story, a number of months later I was able to wean her from the olanzapine. She did great after that, however, the money she saved for coat went to pay the fine that the judge imposed on her.

You know, I like this idea of telling more stories about true patients. And I hope you’ll indulge me a few more of these anecdotes. Yes, of course there’s a Napa Chardonnay nearby. And no, there is no cat. I feel like such a fake. But I’m glad that you’re here to share these stories with me. Until next time, this is Dr. G saying keep the faith.