Reader, what challenges are you facing right now—and how are you feelings about the future? Now, a more difficult question: what challenges were you facing when you were 10? 18? 25? 30? How did the future look back then? If you have a child, perhaps those challenges come to mind more easily. But as each of us would undoubtedly admit, as we get older and more multifaceted, the challenges we face evolve right along with us. At every life stage, a different crisis arises, from “Am I as good as my friends and fellow students? all the way to, “Have I lived a good life?” My work is rooted in the idea that each life stage brings with it these crises, and it is our responsibility to overcome them in order to grow. A therapist can be of huge value in helping individuals navigate through the high-stress emotions that come along with developmental crises, and emerge as a stronger, happier Self.

No one life stage is harder or easier than any other. That said, it seems we become most cognizant of the existential nature of these crises as we grow into adulthood. From a life-stage standpoint, the decade from age 20 to age 30 is fraught with four huge crises: separating from home, forming an identity, launching a career, finding someone to love. Each one must be navigated and mastered in order to move into a satisfying adult life. And as if each these four hurdles were not challenging enough in their own right, let’s add to the mix certain “vulnerability genes” that can make the navigation path even harder. Today, I want to tell you Charlie’s story. This young adult came to see me at the height of his young-adulthood existential crisis. By taking a genetic test, analyzing his genes, and developing a regimen of both prescription medication and lifestyle changes, we were able to equip him to climb over these hurdles with less self-and-collateral damage, and emerge healthy and whole into full adulthood.

Charlie’s Story:

Charlie* presented to me in deep despair early on in his senior year of college. With his huge football player frame, rugged good looks, and southern charm, to an outsider one would think he had it made in the shade. Yet looks can be deceiving. Charlie was about to flunk out of college, and had been binge drinking, doing the occasional line of cocaine, and getting in bar fights. Last summer, during one of those fights he was struck in the head by a tire iron, had lost consciousness, and reported worsening of his underlying ADHD symptoms and “spells” where he would gaze off into space and “zone out.” In addition, for the past two years he had been suffering from mood swings, irritability, temper outbursts, and insomnia. His MRI and EEG results were normal, and his neurologist referred him to me for evaluation and treatment.

In a lighthearted, humorous tone, Charlie began… “Doc, I’m really fine. My family is making far too much of all of this. I just like to have fun and party like I did in high school. And my sister ‘the lawyer’ (she was actually a law student) is just too conservative. My parents expect me to be just like her but I am my own man. And those other shrinks I saw made me worse. One prescribed Zoloft and it sent me out of my mind. I got mean and filled with anger and couldn’t sleep but a few hours a night. And the Adderall made me real hyper and amped-up like I had OD’d on speed or something. I’d be better off if everyone just left me the f**k alone!”

Charlie said all of this in front of his parents and sister in his first session, and while he was talking, each of them began squirming in their seats. His Mom burst into tears and spoke of how afraid she was of getting “the call” that other moms she knew had received—the one where you are told that your son was dead. His Dad looked on sternly in silence. And Charlie’s sister confronted him with, “You are making Mom and Dad and me sick with worry over you. Shame on you. Do you want to end up like Jimmy and Buddy?”

Jimmy and Buddy were two of Charlie’s former high school friends—one had died in a car accident and the other had committed suicide. Their deaths demonstrate how overwhelming the struggle to overcome existential crises in emerging adulthood may become for many young adults—and how important it is to seek out help while you can, just as Charlie was doing.

It was my turn. My goal was simple: I wanted to help Charlie understand he was not alone in suffering these developmental challenges—and that overcoming them is crucial to our wellbeing. I decided to focus on two challenges in particular: His separation from home and forming his own identity.

“Charlie, we all like to go out and have a good time, and of course you have to be your own man and make your own decisions, not the ones that ‘Mommy’ and ‘Daddy’ tell you to. I respect that. You have to find your own way through life and figure out what that is. At the same time, some thing or things have been interfering with how that’s been going for you, and that knock on the head, while it put you to sleep for a while, was a wakeup call of sorts. If your life goes on as it has been recently, what do YOU think will become of you?”

For the first time in the session he looked serious, thought for a moment and then looked me in the eye, “Doc, my sister is right, I might end up like Jimmy and Buddy, and I just can’t do that to my family, or my girlfriend Bonnie. Can you help me? What’s next? What’s my diagnosis? Is it serious?”

I told Charlie I wanted to wait to make a diagnosis until we had more information. I explained to them the role of genetic testing, and everyone agreed that made sense, particularly since he had done so poorly on two other medications.

Analyze Your Genes to Overcome Existential Crises

Meeting life’s challenges head-on can be intimidating for all of us—in fact, it can feel like a battle with life-and-death stakes. I wanted to give Charlie every single tool he needed to overcome these challenges of emerging adulthood, and that meant analyzing his genes to see where he may have mental health vulnerabilities. After all, being in good mental health is a huge factor in being able to overcome one’s life-stage crises. As it turned out, Charlie’s genetic test results were most relevant to his struggles.

Charlie had the following genetic variants: SLC6A4 L(G)/S (one of two reasons he had an adverse response to Zoloft, the second had to do with his being misdiagnosed with an agitated depression), CACNA1C (the “roller coaster ride/mood swing gene”), COMT Val/Val (associated with poor executive functioning and working memory), and MTHFR (the brain’s “supply chain manager” for producing critical mood-regulating neurotransmitters like serotonin, norepinephrine and dopamine). These genes created a greater vulnerability in him for being overwhelmed by  the life stage challenges he faced. Yet at the same time they provided me a clear path forward for more precisely prescribing corrective medications. Charlie and I met alone the next time.

“Charlie, I believe you have Bipolar 2 Disorder. In addition, you are struggling with some of the life-stage challenges faced by any young adult.” He didn’t even hear my second statement, as he was extremely distressed over being diagnosed with Bipolar Disorder. “No Doc, not bipolar, I can’t be bipolar, I just can’t and won’t accept that under any circumstances. Bonnie will break up with me.” And with that he got up to leave the office. Fearing he might never return, and then would end up incapacitated or worse, I quickly blurted out, “Well, Charlie, it could be temporal lobe epilepsy instead of a bipolar condition, as a result of your traumatic brain injury. Oftentimes this diagnosis can mimic bipolar disorder, and EEG results are usually negative. I have treated many war veterans with symptoms just like yours, who sustained closed head injuries, and over time their problems were clearly seizure-related.” He stopped in his tracks, turned around, and said, “What’s that, Doc? I never heard of that before. Me, an epileptic? How could that be as with my spells I never pass out?” I told him that if he sat down I would explain, and lo and behold this was a much more acceptable diagnosis for him

And so we embarked on a course of treatment that lasted for over two years. We stabilized his mood swings (his “spells”) by addressing his calcium channel gene variant with calcium channel blockers (that also happen to be anticonvulsants), carbamazepine which helped some, and then added lamotrigine which began to bring about a dramatic improvement. His mood swings and spells subsided, and his sleep improved. Next we addressed his cognitive impairment as his COMT was destroying too much of the dopamine and norepinephrine he needed for executive functioning and working memory. By adding Modafinil we increased these neurotransmitters and improved cognition, while not destabilizing his moods which would be the risk with the typically-prescribed stimulant medications.

We met weekly for talk therapy, and helped him grieve the loss of a number of high school classmates who had died untimely and horrifying deaths by overdose, automobile accidents, and in Afghanistan. We helped him separate from his parents and become less emotionally dependent upon them, and turn toward Bonnie for emotional support, love, and intimacy.

Turn Your Life Around with a Simple Cheek Swab

Reader, life is challenging. We have so many crises to overcome, and if we are not in good mental health, the challenges become even greater. You can give yourself a head-start and a significant advantage in overcoming these challenges by working with a psychiatrist skilled in interpreting a genetic test and providing a more personalized, precise approach to restoring your mental health.

Charlie just turned 25. He has a good job and last year he and Bonnie married and purchased a single family home. Last month they paid a surprise visit to our offices, to present the newest addition to their family—Cora—a beautiful baby girl. They seemed so proud and happy. And it was almost five years to the day when Charlie first walked into my office. What a transformation. I couldn’t have felt more proud of him if he had been my own child!


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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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