BLOG No. FORTY TWO

Welcome back to my blog on anxiety and depression. Because I have spoken so much on D2 dopamine, I decided to tell you about a pure SSRI case, where there wasn’t any dopamine involved. I believe pure serotonin cases are more rare than most people think. But now and then I run into them.

Jim was a 76-year-old man that I had taken care of for sometime. Other than some high blood pressure and high cholesterol he was the picture of health. Him and his wife were active retirees and played tennis in a local club.

His wife was not my patient, but when he told me that she had passed suddenly from a massive stroke, I was saddened, as she often accompanied him to his appointments in my office. After her death, he came in every six months for bloodwork and refills. I had not seen him in a while, as he was seeing what of my nurse practitioners. But on this occasion, he asked specifically to see me. It had been three years since her death. I asked him how I could help.

What he told me, shocked me. Since his wife’s death, he watched her recorded funeral service every night…yes, every night. For three years, 365 times a year, he watched her videotaped funeral service. He knew every word to every song, knew the words to every scripture that was read, and had the entire service memorized from beginning to end. Yeah, I agree—a little heavy…maybe it’s time for joke break.

What is the difference between in Irish wedding and an Irish funeral? One less drunk!

My first thought was OCD (obsessive compulsive disorder). I mean, the man watched the same funeral every night for three years in a row. But when I queried him regarding racing thoughts, 0 to 60 anger, rapid mood changes, insomnia, and other D2 dopamine issues, he said no to each.

He additionally noted that a nice lady at church had invited him to lunch numerous times. He always said yes, but found a way out of it when the time rolled around for the lunch date. He would feign illness or a last minute errand that needed to be ran. He knew his actions were harmful to himself, and hurtful to her. He wondered what I thought about all of that.

I asked further questions regarding family history of alcoholism, previous depression, for anything that might corroborate a D2 chemistry.

Nada..nunca…nothing. There wasn’t one D2 symptom in him or his family. I capitulated to a pure serotonin chemistry with no D2 involvement.

So I started him on an SSRI and asked if he would return in 3 to 4 weeks. When he did come back for follow-up, his demeanor had completely changed. He had gone to lunch with his nice church lady, and had returned the videotape to a drawer by the TV. He never watched it again. My diagnosis of OCD was spot on. But it rose out of grief and depression. And it was a milder type of OCD, completely treated by the serotonin medication. Footnote: they married about a year later.

Well, my plane is landing in Dayton. My wife has promised to open a nice Chardonnay when I get home. But she hasn’t promised to let me drink it. Until next time when we discuss PTSD, this is Dr. G saying keep the faith!