BLOG No. TWENTY FOUR

Welcome back to my blog on anxiety and depression. Today, my case study is, as promised (I remembered this time!) PANDAS. Now this is not the cute, cuddly bear that eat the shoots and leaves of the bamboo tree.

PANDAS, stands for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. Yep, say that three times fast!

My story begins with an elderly neighbor passing away. His daughter, who was in her mid 60s, stayed in his home after he died, to help show it to realtors and to show a presence in the home to dissuade theft. One Saturday afternoon, she knocked on my door, asking if I can watch the house while she traveled south of town. She stated that her grandson had an emergency. Of course, the doctor in me had to inquire just exaclty what the emergency was.

She told me that her grandson had been diagnosed with PANDAS and was having one of his “spells”. During his spell, he would walk in circles in his room, counting the number of times he stepped in each direction to make sure they were even. (Classic obsessive-compulsive disorder, OCD). He even obsessed over food and had lost over 20 pounds (more OCD). I had of course heard about PANDAS but had never seen a case.

She told me he was at risk of being placed in the hospital and put on a feeding tube. I asked her what they were treating him with, as far as medicines.

I knew the answer before she replied. It seems like everyone treated OCD with serotonin drugs.

“Zoloft,” she answered. I must have a rolled my eyes back into my head, because she quickly asked me, “It’s obvious that you think that is not the right medicine.”

“No,” I replied. I explained that my experience has shown OCD was more of a D2 dopamine issue. When you lower D2 dopamine in OCD patients, they get better. I had treated hundreds of patients with OCD that way.

“Could you see him?” she asked.

“Of course,” I nodded, promising nothing, as I had never treated a PANDAS patient before. But I felt like OCD was OCD. Soon, this young man was staring at me, along with his mom, probably thinking I was just another lame doctor. They had every reason to believe that.

Due to the gravity of the situation, facing a feeding tube, I started with Zyprexa, as it worked quickly. Immediately, we saw a response. In a matter of five days he was 50% better. But when I tried to raise the dose, he got sleepy. So I kept him on the original dose and added Depakote, which I ramped up over about 10 days. The pacing stopped, the obsessions over food stopped, and the exhausted parents got their son back. Soon, the young man was back to playing hockey.

Because they were driving 45 minutes to see me, I told him that they could have the meds filled with their local pediatrician I gave them my cell phone in case they have any questions. I never saw or heard from the young man again.

I don’t tell the story to flaut my skills, but to prove OCD disorders are primarily D2 dopamine related. OCD is one of the many faces of D2 dopamine excess, along with mood swings, racing thoughts, sudden anger and insomnia to name a few.

Well, see that my Chardonnay glass is empty—okay, I lied. I am actually drinking French Sancerre. I feel cheap and adulterous. But it is so good! So until next time this is Dr. G saying, keep the faith!