“It’s like you have two brains — a rational brain and an irrational brain. And they’re constantly fighting.”

– Emilie Ford

 

“The capacity to manipulate genes represented nothing short of a transformation in genetics. We had learned a new language. We needed to convince ourselves, and everyone else, that we were responsible enough to use it.” 

 -Siddhartha Mukherjee, M.D.

Reader, nightmares are a reoccurring element in our cultural lexicon. We empathetically utter the words, “What a nightmare!” when friends or family tell us of their bad days, we describe horrible events as “living nightmares”, we explain our feelings of lightness after a difficult period as “waking up from a bad dream.” But what happens when the stuff of nightmares become our living, breathing reality? What happens when you truly can’t wake up from your bad dream? In my practice, I see many high-functioning, intelligent individuals who suffer from a range of wide range of emotional illnesses. But some have experienced such harrowing visions and experiences that the very reality they find themselves in begins to fracture. Their world looks drastically different than the one you and I may see—often they have one foot in each of two worlds at war with one another, and struggle to make sense of their discontinuous experience of themselves and life. When this occurs, my work is cut out for me. In order to help them regain perspective and a healthy sense of what’s real, I use personalized precision psychiatry to determine how their emotional world and sense-of-self got skewed in the first place. Both prescription and non-prescription regimens can help end the nightmare, once and for all.

It’s important to understand that this experience of a fractured reality can take hold in anybody, regardless of income, class, or other similar factors. It’s equally important to understand that in each of these individuals, the genetic roots of the fracture can absolutely be addressed effectively. Nobody should be stuck inside their nightmarish inner worlds forever. Genetic testing can provide a way out, and a roadmap for the journey back into the light.

Janice’s Story: The Demons that Beneath a Picture-Perfect Life

To most anyone who loved or worked alongside her, Janice was the picture of success. She had co-founded a consulting company, had been married for 25 years, and had raised two loving children. On the outside she appeared to have everything anyone could ever dream of, but deep inside her heart and soul an almost continuous, raging battle was gradually consuming her. It all began with a nightmare from which she awoke screaming. In the dream she had been struck by a bolt “from heaven” which had annihilated her, causing instantaneous death. At the time she first woke up in terror, she recalled an event from early childhood, where lightning had struck her family’s home and caused a devastating fire that burned it to the ground. In the days and weeks that followed the nightmare, she began to have recurring intrusive thoughts that the Devil was trying to steal her soul, or possess her, or transform her into some kind of “monster” that would kill someone. She could distract herself from these thoughts by throwing herself into her work and family responsibilities, and spending more alone time praying to God to end her torment, but these coping mechanisms began to fail her. She developed panic attacks which were treated with Valium (diazepam) by her family doctor, yet these attacks began to escalate in frequency and intensity, which ushered in the onset of a major depression. She then saw a psychiatrist who misdiagnosed her as suffering from schizoaffective disorder, and placed her on Seroquel (quetiapine), even though Janice did not manifest any hallucinations, disorganized speech, grossly disorganized behavior, or so-called negative symptoms characteristic of that condition.

When she first entered my office her profound terror was palpable. “Dr. Kehr, I am losing my mind, and if that continues, we will lose everything – our house, our cars, our entire way of life… my husband is a musician and receives little income from his work. Only he and my best friend Sharon know about all the crazy thoughts and noise inside my head, and to everyone else I appear entirely normal. I feel that Satan is trying to possess me, like that girl in that movie ‘The Exorcist,’ and if he succeeds, I will succumb to Him and commit some heinous crime. I pray to God, and sometimes my prayers are answered, but I feel that Satan is gradually winning-out. I am a deeply religious woman, but my faith is being severely tested. Can you help me?”

I listened intently as Janice told me her story, and my heart went out to her for the undue suffering she was caused by her misdiagnosis. “Janice,” I told her gently, “I know you feel like you are at the end of your rope—and I can tell how deeply fearful you feel right now. But I believe precision psychiatry may be the answer to your prayers. By taking a look at your genetic makeup, we can pinpoint the nature of your suffering, and begin to address it directly.”

Using Your Genes to Take Back Control of Your Mind: What Janice’s Genetic Test Results Showed

Believing she was suffering from OCD, possibly complicated by PTSD, (and not schizoaffective disorder) we immediately began her on Luvox (fluvoxamine), and ordered a Genecept Assay, an MRI of the brain, and blood tests. The MRI and blood tests were all normal. Genecept revealed SLC6A4 S/S, an “Orchid Gene” and her other genes were all normal variants. As the fluvoxamine had brought about a partial treatment response despite her SLC6A4 results predicting a poor response, I tried to “augment” it with a series of additional medications. The addition of an atypical antipsychotic only made her worse so it was discontinued. She began weekly psychotherapy with a therapist who specialized in PTSD, after an adequate trial of exposure and response prevention therapy for OCD had failed to provide any meaningful improvement.

Because her anxiety and stress levels continued to be debilitating, I wondered if she might have a genetic predisposition to an excessive “fight, flight or freeze” (HPA axis) response to stress. To answer this question, we performed a Mindful DNA genetic test, which revealed variants in CRHR1, FKBP5 and OXTR genes. To epigenetically modify the expression of these genes, we added N-acetylcysteine (NAC), Ashwagandah, and Phosphatidylserine to modulate her over-reactive, prolonged stress response, and I encouraged her to seek out additional emotional support. After three months on this regimen there was some further improvement, and Janice reported herself about 60% better. Despite these improvements, Janice was still trapped in an emotional firefight between God and Satan. Wanting to leave no stone unturned and do whatever it takes to try to bring about a full recovery, I then consulted with scientists from the Genomind Medical Affairs team.  For my most treatment-resistant patients, they often can provide me with a physiological pathway or targeted treatment that I hadn’t considered yet. As it turned out, their ideas led to some very positive developments for Janice.

Reaching Full Recovery: How Personalized Precision Psychiatry Helped Improve Janice’s Quality of Life

The Genomind scientists pointed out that the Luvox, which had brought about some partial reduction in Janice’s recurrent intrusive thoughts and depression, might have been making her anxiety worse. Here’s why: her SLC6A4 S/S variant meant that she had too few serotonin “reuptake pumps” and therefore her brain’s synapses were flooded with serotonin when she was under stress. This would cause an over-activation (“emotional hijacking”) of her amygdala, which then activated that “fight, flight or freeze” response by further increasing her Adrenaline and Cortisol stress hormone levels. They asked me to consider weaning her off the Luvox and starting Clomipramine, a tricyclic antidepressant first discovered in 1964, which I began right away.

In addition, they pointed out that her CRHR1 and FKBP5 genes, by causing chronic activation of her HPA axis, resulted in glutamate overactivity that leads to oxidative stress and inflammation in the brain and throughout the body. This would also result in dysfunction in her mitochondria, the thousands of “power plants” that produce energy inside each cell.   One month later we embarked upon a new strategy to reduce the effects of “glutamate dysregulation” in her, and boost her cellular energy production. Glutamate is known as an “excitotoxic neurotransmitter” and so I prescribed a series of medications and supplements to reduce its effects in the brain. We added Namenda (memantine, which unfortunately made her worse), Equetro (which offered some additional relief), and gabapentin (which brought about some additional reduction in the frequency and intensity of her intrusive thoughts). We also added CoQ10 and Omega 3 to reduce inflammation and boost cellular energy production. Over the next three months, low and behold this complex, targeted regimen began to make a significant difference in her quality-of-life.

Janice is far from out of the woods. She continues in psychotherapy to overcome that childhood trauma, and God and Satan continue to battle inside her. But they engage more in minor skirmishes now – no longer the global emotional warfare she once endured. We continue to aim for a full recovery. Time will tell.


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*Although lessons learned from the treatment of actual patients are included in the patient stories on this website and blogsite, the historical events and facts represented have been changed to protect the identities of any real patients and to protect their confidentiality. For example, the names, ages, careers, the number and sex of their children, as well as the careers of the patients’ parents have been deliberately altered, as well as other alterations that have been made. Consequently, all characters appearing on these sites are fictitious. Any resemblance to real persons, living or dead, is purely coincidental.

**(Dr. Kehr holds no ownership interest in Genomind and receives no consulting fees)

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