• Bipolar Depression: Monica’s Story

    bipolar depression

    The anti-determinists want to say that DNA is a little side-show, but every disease that’s with us is caused by DNA. And (every disease) can be fixed by DNA.

    - George Church, “From Designing the Molecules of Life to Designing Life

  • Bipolar Depression: Monica’s Story

    When Monica first came to see me at age 42, she felt like a complete mess. As she listed off her symptoms, I could understand why: low energy, racing thoughts, mood swings, poor memory and concentration, difficulty sustaining a focus, easy distractibility, and insomnia were all impeding her ability to feel whole and live a normal life. Monica had a childhood history of ADHD. She was also 100 pounds overweight. Now, it would’ve been one thing if Monica had never been treated for these and other symptoms. But in fact, Monica had been diagnosed with Bipolar I Disorder ten years earlier. Those who suffer Bipolar I Disorder experience more intense manic episodes than Bipolar II patients—accordingly, she’d been previously prescribed Lithium, Lexapro, Clonazepam, Lamictal, Seroquel, and Abilify. There were also past trials of Vyvanse and Depakote, along with a number of other medications that she couldn’t recall. A decade of treatments had not made any meaningful difference. How was that possible?

    Monica was a smart woman—brilliant, in fact. She had achieved a Ph.D. in Physics, and had once worked at a prominent laboratory in a largely male-dominated field, and had distinguished herself in the field of quantum mechanics. And yet in those ten years, she still couldn’t answer that crucial question: Why am I not getting better? Perhaps she thought that question was rhetorical—but I had an answer. What she needed was a precise, personalized treatment plan, tailored to her unique genome. As I explained to her that a genetic test would give me a clear picture of her genetic vulnerabilities and how our her would address each of those vulnerabilities in turn, I saw a flash of hope spread across her face. It had been a hard ten years—but over the course of the next 18 months, Monica’s life began to transform.

    First, we performed Genomind’s Genecept Assay, which revealed variants on her 5HT2C, MTHFR, COMT, CACNA1C, and CYP2C19 genes. Her severe weight gain could be attributed to the Seroquel, Abilify, and Lithium, so we gradually tapered her off these medications and substituted Vraylar (much less blockade of 5HT2C than Seroquel and Abilify), and Memantine (blocks the calcium channel without the weight gain associated with Lithium), and added l-methylfolate 15 mg daily. This process took about 6 months, and she began to feel and function better. We also began to increase the dose of her Lamictal as it is a calcium channel blocker and also lifts and stabilizes mood. We tapered the Clonazepam as it was causing fatigue. We added Wellbutrin to address her COMT variant and her focus and distractibility began to improve. She began to lose weight and feel more optimistic.

    By the end of those 6 months, Monica reported feeling about 75% better. To help her reach 100%, we performed Genomind’s Mindful DNA Assay. Based on her test results, we added a Mediterranean Diet, Vitamin D and Melatonin to modulate her CD33 variant to help with cognition and reduce glial cell inflammatory signaling; and the Mediterranean Diet also helps with weight loss and reducing the effects of metabolic syndrome resulting from her FTO, CLOCK and PPARG gene variants. N-Acetylcysteine was added to modulate CHRNA5/3 and FKBP5 genes to reduce her HPA stress response, and she began a regular exercise program to address MIR-181. Finally, she joined a local book club to develop some friendships, enhancing her social support to address her OXTR variant.

    Weight gain can make those suffering from Bipolar Disorder feel significantly worse than before. Helping Monica shed over 100 pounds in total had a crucial impact on her overall treatment! Not only did it improve her self-esteem, it also dramatically reduced the inflammation in her body that wreaks havoc on brain cell function, and predisposes to higher rates of cancer, heart disease, stroke and Alzheimer’s Disease. Flash forward 18 months from our first visit, and we had a “brand new” Monica. What a remarkable journey she and I had completed to bring her to wellness, to the point where she entered the session smiling and happy – a feeling she hadn’t experienced for many years!

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