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    Combating Depression in a Combat Veteran: How a Wounded Warrior was Healed through Genetic Testing

    Dear Reader, I live in the D.C. area, just up the road from the Walter Reed National Military Medical Center, and not too far from The Pentagon. All cities have personalities, and each tells a story, if we’re willing to listen. D.C.’s personality is patriotic, and its story is the story of America, rooted in sacrifice, politics, and a shared vision of a nation. The buildings, the memorials, the very fabric of this city ensure the American Story is never far from mind. And that story was built, and fought for, by our troops. The sacrifices that saved this country time and time again were their sacrifices. I consider myself lucky to live in a city where I have the opportunity every day to thank the people in uniform who put their lives on the line for us time and time again. Where would we be without them? To most of us, war and defense operations are brutal realities that we’d like to keep out of sight, out of mind. Unfortunately, that position all too often leaves our soldiers out of sight, out of mind as well. This truth is even more brutal when you realize that these soldiers are prone to suffering far worse mental health fates than many of us because of the sacrifices they’ve made.

    Reader—It’s not Veteran’s Day. Memorial Day is still a month away. But to me, there does not need to be a holiday in order to recognize our troops. And in this blog, I want to illustrate the depths of their pain—and show you how hopeful their futures could be, if only we dedicated the time to help them out of their sorrows.

    Steve’s Story: A Soldier’s Depression

    Steve* was the kind of guy you couldn’t help but like. This soft-spoken, gentle man from the Deep South had intense blue eyes that met mine with a warm gaze, yet hinted at a deep sadness and pain. I’ll never forget the incredible humility he showed during our first session as he told me of his many combat missions flying F-16 Fighting Falcons in Operation Iraqi Freedom. After returning from his deployment, Steve started a family with the woman he loved and launched a successful cybersecurity company with over 300 employees, including some of his wartime buddies. After receiving his introductory briefing, I thanked him for his service. “Without people like you, Steve,” I told him, meeting his gaze directly, “the freedoms we enjoy in our daily lives would quickly evaporate. You preserve and protect our way of life, and my family and I are deeply grateful.” He looked a bit embarrassed as he thanked me—how refreshing his humility was in today’s deeply politicized world! I kindly responded, “What brings you in today, Steve?”

    He paused to gather his thoughts for a moment before muttering, “Doc, being in the military has done a number on a lot of my friends, and me too. I haven’t felt good in a long, long time. And I worry that if I don’t figure out why, I’m going to lose everything I fought for.”

    Steve grew up with a highly critical father he could never please and a passive mother who let her husband physically abuse their children. Under these circumstances, Steve’s depression grew from an early age. He couldn’t wait to leave home, and when he gained admission to the Air Force Academy, he finally got his chance. Steve quickly found that the high-pressure, high-intensity world of the Air Force made him forget about his pain—in response, he threw himself into his work. During his deployment in Iraq, he flew over 2,000 hours and was awarded The Distinguished Flying Cross. Every mission gave him an opportunity to ignore his depression—until one day, something terrible happened that made his illness return with a vengeance. His friend was shot down and perished in a ball of fire. Such a terrible death would rock the world of even the strongest soldier. For Steve, it triggered a deep trauma he’d been trying for years to avoid.

    His struggles to keep his depression at bay continued as he returned back home to the States. As the challenges of running his company had grown in scope and complexity, he had become increasingly withdrawn and was actively considering resigning from his leadership position and having a Board member take over. Steve was smart enough to know that he needed help. I’m glad he chose me as his psychiatrist to guide him through years of trauma to finally grasp at the prospect of becoming whole for the first time in his life.

    A Ray of Hope: How Analyzing the SLC6A4, COMT, BDNF, ANK3, CRHR1, and FKBP5 Genes Can Help Ease Depression for Good

    Given how much Steve had contributed to our nation, and all the death and destruction he had to witness firsthand, I felt all the more compelled to try to bring about rapid resolution of his symptoms. After he bravely told me his story, I replied, “Steve, you’ve been through a lot—and yet you have every reason to expect a bright, beautiful future ahead as you continue in your business and raise your children. Our bodies are adaptable in ways many of us aren’t aware of, and one of the ways in which we can help you through your depression is by analyzing your genes and seeing what we can tweak using both prescription and non-prescription interventions to give you have a better chance of feeling better. We are going to swab your cheek at the conclusion of our session today, and send it away for genetic analysis, to determine your personal genome and create a roadmap to recovery. We usually just perform the Professional PGx “Mental Health Gene” Assay in the first visit, but given how badly you are feeling, and that your nature is one of demanding rapid results, how would you feel if we also performed the Mental Health Map “Brain Health Gene” Assay as well?”  Steve thought about it for a moment, briefly smiled, and said, “Yeah, I am kind of action-oriented, doc. I’m in for both.”

    One week later we met again to review the results. Sam had the following genetic mutations: SLC6A4 L(A)/L(A) (as you may recall, this gene can include a type of variant that makes SSRI’s a poor option for the treatment of depression—but Steve’s variant predicted a good response!), COMT Met/Met (one of the “orchid genes”), BDNF Val/Met (low on “brain fertilizer”)  ANK3 C/T (one of the “roller coaster ride genes”); and CRHR1 and FKBP5 (two of the “Fight, Flight or Freeze” stress-response genes). Armed with this information, we addressed each of these genetic variants simultaneously using both prescription medication and supplements, as I was determined to achieve a rapid recovery in him.

    Steve’s regimen included the SSRI Paroxetine to help boost serotonin levels in the brain’s synaptic connections, as we determined from his SLC6A4 variant; N-Acetylcysteine (NAC) to address his COMT, CRHR1, and FKBP5 variants (here is an example of how one epigenetic modulator, NAC, can downregulate multiple genes simultaneously!); and a combination of high dose Omega 3 and microdose lithium (less than 1/1000th the dose we use to treat bipolar disorder), both of which increase BDNF and modulate ANK3. By the end of the first month, Steve no longer felt like quitting his job and had resumed traveling to customer sites. By the end of two months he had fully recovered. And best of all, by the end of three months he felt the best he had in his entire lifetime. Not only had we addressed his acute life crisis, we had resolved genetic vulnerabilities he had been born with, that had begun to express themselves during his troubled childhood!

    Don’t Give Up: Use Genetic Testing to Create a Gene-Based Roadmap to Better Health

    We went on to work together in psychotherapy, to help Steve deal with his overly demanding, perfectionistic self, which had served him well flying at 1500 miles per hour in that F16, but actually served to impair him at home and in the business world. As of this date, he is beginning to recognize its origins in his childhood relationship with that father he could never quite please.

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