Loading...

Follow Dr. Bruce A. Kehr on Feedspot

Continue with Google
Continue with Facebook
or

Valid

“Knowing yourself is the beginning of all wisdom”

                                                     Aristotle, 4th Century BC

“In the twenty-first century… we are constructing a new epidemiology of self: we are beginning to describe illness, identity, affinity, temperament, preferences – and, ultimately, fate and choice – in terms of genes and genomes. The influence of genes on our lives and beings is richer, deeper, and more unnerving than we had imagined.”

                                                     Siddhartha Mukherjee, M.D., 2016 AD

Reader, what’s in a name? When William Shakespeare first posed this question, what followed was some of the most memorable romantic language in the Western canon. That which we call a rose by any other name would smell as sweet… Now, I promise this space has not been transformed into a literature blog. But I do want to focus on that question for a moment—because in my field, the act of naming something holds deep significance. Shakespeare directed his question “What’s in a name?” toward a person, but I’m directing it toward something else: the naming of emotions, feelings, and states of being. Because you see, reader, it is only when we are able to name something that we can fully bring it into our consciousness. Naming something empowers us to reflect—and it empowers us to assess what may need to change.

One aspect of daily life that most people never consider is their emotional life and emotional health, and yet they are the foundation for everything we feel about ourselves and our lives. In fact, simply being able to name and acknowledge our emotional states is half the battle in the journey towards wholeness. The other half of the battle is where the real work lies. Once you can name an emotion, questions arise: What am I supposed to do with it? I don’t like how this feels… how can I feel different? Am I going to be stuck in this state forever? To do this work, you need every tool at your disposal. But emotions are heady things: what works for you may not work for your friend. Your emotional life is rooted in experiences, contexts, and biology that is entirely unique to you. How, then, can medicine or psychiatry begin to help? That’s exactly what we’ll be covering today and in the next few weeks, as we embark on a new blog series that will shine a spotlight directly on the DNA of your emotional health. Are you ready? Let’s dive in.

A Rose by Any Other Name… Your Emotional State is Unique to You

If naming emotional states is half the battle, the other half is embarking on a shared journey toward becoming whole. Given that helping others brings us enormous joy, you can imagine how joyful we become when people call our office seeking help—often for the first time in their lives—or when they’ve been treated elsewhere and are still not feeling well. But the emotions these individuals describe to us on the phone are absolutely impossible to generalize. Below are just a few of the recent calls we’ve received from individuals who are naming their emotional states and looking to get to the bottom of how to resolve them:

“I am experiencing a lot of anxiety and depression, I have never taken medication before and I am wondering if a professional opinion, a diagnosis, needs to be made.”

“I am calling because I am concerned I may have ADD/ADHD, I find it hard to focus and it affects my daily life, I want to do something about it”

“I am calling for my child who is lashing out and showing other behavioral problems, we want them to meet with a professional so we can manage what is going on”

“I am calling because I am interested in genetic testing, can you give me more information about it?”

“My family member is experiencing (paranoia, addiction, depression, anxiety) I am calling around for them, to help them find a doctor to help.”

“I am calling for a second opinion. I have been diagnosed with (bipolar disorder, borderline personality disorder) and don’t feel my (diagnosis is right) or (prescription is working)”

“I have experienced depression, feeling lethargic and sad, often moody, I want to do something about it because it is starting to hinder my daily life”

“I’m currently looking for a new psychiatrist and read Dr. Kehr’s blog and I am really interested in seeing him. I am looking for someone who won’t just give me medication. I want a doctor that treats the whole person.”

“I am interested in having my child come in for genetic testing. She has tried and failed a lot of medication. Can you tell me how to go about doing that?”

I’ve practiced psychiatry for 40 years, but the courage my patients display in these calls never ceases to amaze me. It takes guts to realize that, as just one example, your inability to get out of bed in the mornings—or at all—may be something more than lethargy. And it takes even more “heart” to bring that suspicion to the doctor’s office and begin to work together to heal it.

But let’s take that single example a step further. Once I see a patient who displays signs of depression, I assess them holistically. Using the Biopsychosocial Model as a guide, I not only take steps to uncover their internal and external lives, and their life stage challenges—but also their personal genome, through a simple cheek swab. The reason why is simple: “depression” is a blanket term that manifests in very different ways in my patient’s lives, and depending on their biology and internal and external factors, certain treatments may work while others do not. This sort of “n-of-1” treatment is known as Personalized Precision Psychiatry℠—and when it comes to really working through our emotional lives step by step, nothing is as effective in the long run as this type of approach

What’s in a Cheek Swab? How Your Genetic Code Can Unlock your Emotional Health… and So Much More

A fundamental tenant of my practice of Precision Psychiatry is to recommend genetic testing, through a simple cheek swab, to every single one of my patients. I then send the cheek swab to Genomind’s labs, and they provide an assessment of my patient’s mental health (and/or brain health) genes. In our new blog series, we’ll be focusing on newly assayed genes from Genomind, along with a new look at some of the earlier genes we covered, which will help to further clarify the amazing ways in which our genes can impact our emotional health—for good or for ill—and how we can in turn impact our genes through lifestyle changes, supplements, and medications.

To refresh your memory in anticipation of this new series of genes, I encourage you to watch the short video below, which explains succinctly how DNA and genes actually operate in your body—and how you can influence your genes just as they influence you

From DNA to protein - 3D - YouTube

In our prior genetic series, we’ve focused on how personalized precision psychiatry  pairs with genetic testing to allow your psychiatrist to prescribe the right prescription medication for you, as well as non-prescription supplements and lifestyle changes that can have a great impact on your wellbeing. We’ve even shed light on how genetic testing and precision medicine has changed my patient’s lives when they’ve come to see me after a long and fruitless search for help elsewhere. In this new series, we’re taking a closer look at how genes impact our emotional states—how they actually work inside our cells—and also how our ethnicity and other “genetic and epigenetic inputs” work to bring about states of being that are unique to preserving, protecting, and improving upon our emotional health.

Your Genes, Your Emotional Health: What Lies Beyond?

Reader, what’s in a name? This time, I ask in a more Shakespearian line of thinking. Your genes, like your name, are an inescapable part of who you are. But also, like your name, they don’t have to define you. You are so much more—and you owe it to yourself to find out what lies within each of the 32 trillion cells in your body and beyond, just waiting to be called into service to improve your happiness.

Help others. Please click the social buttons below to share these weekly insights with those who may benefit.

National Genetic Testing and Second Opinion Consultations

If you would like to feel well and recover your health, make an appointment for DNA Testing  or request a Second Opinion from Potomac Psychiatry.

Read my Amazon Best Seller Book,  ratings on Amazon and Goodreads,  Becoming Whole: A Healing Companion to Ease Emotional Pain and Find Self-Love, if you would like to feel better through genetic testing, and improve your love relationships.

Proceeds from your purchase of my book will be used to directly help rape survivors and victims of child abuse through donations to RAINN

*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)

DISCLAIMER

The post The DNA of Emotional Health – Part 1 <br> What is Personalized Precision Psychiatry? appeared first on drbrucekehr.com.

Read Full Article
  • Show original
  • .
  • Share
  • .
  • Favorite
  • .
  • Email
  • .
  • Add Tags 

Reader, nothing is more empowering than the feeling that our lives are finally coming together—we’re working towards something, we’re building something great, we’re growing, connecting, and loving fully and completely. In other words, we’re blossoming. On the flipside, nothing is more disconcerting than the feeling that, suddenly, all of that “togetherness” is falling apart right before our eyes—when this occurs, we feel the great thing we were building was just a lie, that we were deluding ourselves thinking we could have grown or changed, that we’re not just back to square one in terms of our personal evolution—we’re worse off than where we were before. We’re not blossoming—we’re wilting. Oftentimes, this seemingly catastrophic struggle aligns with a crisis tied to the life stage in which we find ourselves: when we are fresh out of college, we feel hopeful about job prospects and devastated when we don’t land the career we longed for. When we are in a serious romantic partnership, we see a bright and promising future and then that future is stripped away when our hearts are broken. As we illustrated last week in “ Charlie’s story,” each era in our lives is defined by emotional challenges we must overcome—and the process of doing so can often throw us into an existential crisis, where suddenly we look at our lives and see nothing but failure.

Existential crises befall many of us. However, some individuals are equipped with a greater emotional resiliency in the face of these crises, while others may feel that existential pain reverberating through their bodies and minds for months if not years. Reader—this isn’t about one group of people somehow being “better” or “smarter” than the other group. This is about the cards we’re dealt at birth, in the form of our personal genetic makeup. However, those cards are just one part of the story—what really matters is how we play them… and boy, can we play them to our advantage if we understand what we’re working with! This week, I want to tell you about a young woman’s journey toward greater emotional resiliency in the face of an existential crisis, and how a simple cheek swab gave her the tools she didn’t even know she needed. For those of you who have read my self-help book, Becoming Whole: A Healing Companion to Ease Emotional Pain and Find Self Love, you may remember the story of Alice from “Session Six – Letting Go of Your Child as They Become an Adult.” If you haven’t read it, I have posted it at the end of this blog, and you may want to read it now to place today’s story about her into context. Now, let’s dive in!

Alice’s Story, Part Two: Building a Life… Until Everything Fell Apart

Alice first came to see me when she was 17. At that time, she held a lot of anger towards her parents which we worked through over the course of 18 months. Following termination from treatment, over the next five years Alice truly blossomed, attending college down south, participating in sorority life, and successfully majoring in digital communications.

Sadly, Alice recently returned to see me in a crisis, fearing her life was coming apart, and that she was doomed to a bleak future. The good news was she had graduated college, secured a really good job where they liked her, and was in a monogamous relationship with a boyfriend who was going places and who treated her with love and respect. The bad news was that two weeks earlier she had been stopped by the police for driving erratically, and when they searched her automobile they discovered an ounce of marijuana and a half dozen opioid tablets. In recounting this story to me, she suddenly burst into tears, and in confused bewilderment commented, “Dr. Kehr, I don’t know what came over me to blow up my life this way! Everything had been going so well, what could possibly have made me behave in such a self-sabotaging way? I have been reading your blogs on genetic testing and wondered if some of my genes had anything to do with this?”

As I listened to her, I considered her hypothesis. How could her genotype predispose her to lawbreaking behavior? As it turned out, this question led me to a novel formulation about the intersection between her personal genotype and her unconscious mind. As Alice was quite depressed, was unable to sleep, was having suicidal thoughts, and could barely concentrate at work, I recommended that I prescribe an antidepressant for her following a simple cheek swab to genetically test her “mental health genes,” thereby prescribing for her in a more personalized and precise fashion. What emerged from the test report, when combined with her “life-stage story” of recently graduating college, began to explain her Self-Saboteur behavior.

Are Your Genes Responsible? How Alice’s Genetic Profile Explained Her Emotional Breakdown

Alice had 1½ “Orchid Genes” that I have been writing about in recent months (I’ll explain my 1 ½  measurement in the following paragraph). To refresh your memory, while orchids are famous for their stunning beauty and diversity, they are infamous for the extremely delicate cultivation required of them. They require strong light, but not direct sunlight. They need high humidity and good air circulation—specifically around their roots. They need time to dry out, but also require heavy watering, mimicking drenching rainfall. And like Goldilocks, they need just the right temperature, between 50 and 85 degrees. Some individuals are like orchids—absolutely incredible, requiring just the right circumstances to truly thrive. But place these orchid individuals in a “harsh” environment and they will wither—unless they get help.

On Alice’s SLC6A4 gene she had one “Short” allele (1/2 an orchid gene) and her COMT was the Met/Met variant (a whole orchid gene). Her SLC6A4 genotype conferred a somewhat increased “serotonergic tone” (too much serotonin) in her brain’s amygdala, where fear responses are processed, and thus she would have a somewhat higher-than-average fear response and greater response to stress, including a greater release of cortisol, with higher rates of anxiety and depression. Her COMT Met/Met variant would exacerbate the effects of her SLC6A4 gene as it is is associated with “dopamine flooding” of the frontal lobes under stress, which results in increased anxiety levels and cognitive perseverating (ruminating over and over again about things)—also resulting in a higher stress response. Together, these two genes would worsen her “fight, flight, or freeze” response and create higher levels of chronic stress.

“Why Now?” How Existential Crises Map to Important Life Stage Events

Alice’s genes provided an important backdrop to understanding her current life crisis, but the question remained:  Why sabotage her life now? Why the renewed existential crisis? Alice’s story revealed the clues. While in college, Alice experienced a sense of belonging for the first time in her entire life. In high school, she had been a loner that didn’t belong to any social groups, but in college she’d gained a number of close friends and had become a valued and cherished sorority sister. Further, she lived in a community where she had a clear sense of self. In addition her boyfriend lived in the same apartment building, and they spent almost all of their spare time together.

Following graduation, however, this all changed. She lost her identity as a sorority sister and her closest friends moved back to their home towns. Alice’s boyfriend’s job required frequent out-of-state travel, and the location of his office required him to live about 45 minutes from her. In short, she came to feel lonely, all-alone, and bereft. In response to this emotional pain, she began smoking weed in an attempt to ease it, and on occasion took some Oxy with friends. When the police confiscated these drugs from her car, she had been on her way to a reunion with her college buddies.

Alice’s early-adulthood life stage challenges and recent losses, in combination with her orchid genes and her longstanding unconscious predisposition to sabotage her life when under conditions of chronic stress, all conspired together to create this existential crisis inside her.

Exiting an Existential Crisis: With Treatment, It’s Possible

Our treatment needed to address her life stage challenges, orchid genes, depression, insomnia, suicidal thinking and legal challenges. We once again began weekly talk therapy to give her emotional support and help her figure out the unconscious forces that drove her self-sabotaging behaviors. We put her on an SNRI antidepressant that helped reduce her depression and anxiety, and improve her sleep; N-acetylcysteine and ashwagandha to reduce her exaggerated stress response; and I worked with her attorney to get her into an outpatient substance use disorder clinic while she also engaged in community service. Her court hearing is scheduled for next month, and we are hopeful that with my explanatory letter to the court combined with her intensive outpatient treatments she will be granted clemency.

Read “Session Six – Letting Go of Your Child as They Become an Adult.”

For those of you who have read my self-help book, Becoming Whole: A Healing Companion to Ease Emotional Pain and Find Self Love, you may remember the story of Alice from “Session Six – Letting Go of Your Child as They Become an Adult.”  This chapter places today’s story about her into context.  Click the button below to read “Session Six.”

Help others. Please click the social buttons below to share these weekly insights with those who may benefit.

National Genetic Testing and Second Opinion Consultations

If you would like to feel well and recover your health, make an appointment for DNA Testing  or request a Second Opinion from Potomac Psychiatry.

Read my Amazon Best Seller Book,  ratings on Amazon and Goodreads,  Becoming Whole: A Healing Companion to Ease Emotional Pain and Find Self-Love, if you would like to feel better through genetic testing, and improve your love relationships.

Proceeds from your purchase of my book will be used to directly help rape survivors and victims of child abuse through donations to RAINN

*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)

DISCLAIMER

The post How an “Orchid Gene” Fashioned an Existential Crisis in a Recent College Graduate appeared first on drbrucekehr.com.

Read Full Article
  • Show original
  • .
  • Share
  • .
  • Favorite
  • .
  • Email
  • .
  • Add Tags 

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!

Help others. Please click the social buttons below to share these weekly insights with those who may benefit.

National Genetic Testing and Second Opinion Consultations

If you would like to feel well and recover your health, make an appointment for DNA Testing  or request a Second Opinion from Potomac Psychiatry.

Read my Amazon Best Seller Book,  ratings on Amazon and Goodreads,  Becoming Whole: A Healing Companion to Ease Emotional Pain and Find Self-Love, if you would like to feel better through genetic testing, and improve your love relationships.

Proceeds from your purchase of my book will be used to directly help rape survivors and victims of child abuse through donations to RAINN

*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)

DISCLAIMER

The post Graduation Blues: How DNA Almost Sabotaged a Promising Future appeared first on drbrucekehr.com.

Read Full Article
  • Show original
  • .
  • Share
  • .
  • Favorite
  • .
  • Email
  • .
  • Add Tags 

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 Genecept “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 Mindful DNA “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.

Help others. Please click the social buttons below to share these weekly insights with those who may benefit.

National Genetic Testing and Second Opinion Consultations

If you would like to feel well and recover your health, make an appointment for DNA Testing  or request a Second Opinion from Potomac Psychiatry.

Read my Amazon Best Seller Book,  ratings on Amazon and Goodreads,  Becoming Whole: A Healing Companion to Ease Emotional Pain and Find Self-Love, if you would like to feel better through genetic testing, and improve your love relationships.

Proceeds from your purchase of my book will be used to directly help rape survivors and victims of child abuse through donations to RAINN

*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)

DISCLAIMER

The post Combating Depression in a Combat Veteran: How a Wounded Warrior was Healed through Genetic Testing appeared first on drbrucekehr.com.

Read Full Article
  • Show original
  • .
  • Share
  • .
  • Favorite
  • .
  • Email
  • .
  • Add Tags 

Reader, what expectations drive you? Are they motivating or debilitating? Energizing or depleting? Is there the expectation of wealth—a drive toward earning a certain income per year in order to feel successful? What about the expectation of beauty—do you feel nagging guilt and shame for making less-than-healthy choices that sabotage your expectations around weight? Now, let me ask you another question: Who or what gave you those expectations? Are you driven to achieve certain ideals dictated by society? Are you your own worst critic? Or are you still motivated—or haunted—by expectations communicated by your parents? Reflecting on these questions can put any of us on the path toward greater self-awareness and understanding. However, the journey toward adjusting expectations to better suit our needs can be long and at times fraught. Why are happiness and life balance so elusive? Because sometimes it’s not just our own expectations that need adjusting. This week, I want to tell you about Tara. This brilliant woman came from a highly successful family who envisioned a great future for her—and when she began to falter and fail to meet the lofty expectations pressed upon her, she almost crumbled under the weight of her shame. But reader—our failure or success is often not entirely up to us. The vastly complex world of our genes and how they express themselves can work for us or against us. And, as you’ll soon read, sometimes learning how our DNA affects our prospects can help ease the burden of unrealistic expectations… for all parties involved.

Tara’s Story: Buckling Under the Pressure of “Greatness”

Tara* timidly walked into my office and immediately sank into an armchair. With her head held  low, and her face filled with gloom, she began to tell her story. “Dr. Kehr, I once had so much promise, and now I am an abject failure in my life. I have let everyone down, my husband, my siblings, my mother, my friends, and most of all… my father.” And as she mentioned her father she burst into tears, and couldn’t stop sobbing for several minutes. I gently said to her, “Tara, if you don’t mind, can we start at the beginning? When did you last feel well, and what happened to change that?”

When this 42-year-old structural engineer was a little girl, she’d been groomed to become a “star”. Her father was a world-renowned energy industry consultant, who hobnobbed with CEOs of Fortune 500 companies and heads of state of oil-rich countries. Tara had gone to the finest schools, and was told she was destined for greatness. Her parents, particularly her father, had scripted virtually every phase of her life, with the goal being that she, too, would become a global powerhouse—a one-woman force to be reckoned with.

Following graduate school, she went to work at a highly prestigious engineering firm that worked on high-profile projects around the globe. Her job was to lead a team of engineers through multiple projects around the world utilizing highly innovative architectural designs, while adhering to tight deadlines and construction budgets that ran from hundreds of millions to billions of dollars. From the start she struggled. She was unable to effectively organize, plan, and execute. She had trouble sustaining a focus and was easily distracted. Deadlines went unmet and budgets were exceeded. Increasingly overwhelmed, Tara suffered from mood swings, began to become disabled by a major depression, and could no longer concentrate or even remember her day-to-day priorities. In short, she developed an existential crisis that threatened her very professional existence and left her in desperate need of a medical leave of absence. As her world was crashing down around her, she first turned toward her family for help.

Can You Recover from Shame? How Your SLC6A4, CACNA1C, and ANK3 Genes May Help

When Tara went to her father for support, he could not have been less compassionate. “Tara, you are shaming me and our entire family. What’s wrong with you?! Are you drinking? Using drugs? You know the CEO of your company is a close personal friend of mine. I vouched for you when you were interviewing there. You are putting me in a very uncomfortable spot. You need to pull yourself together and snap out of it!”

Tara felt devastated by his words, and by the fact that her mother was present and did absolutely nothing to intervene. As Tara recounted this traumatic talk to me, she said, “My entire life is crumbling, and I don’t know where to turn or what to do about it. My family doctor first put me on Lexapro, then Prozac, then Zoloft, and none of them helped me. In fact they all made me feel worse. A friend told me that your practice uses genetic testing to help people like me, what can you tell me about it?”

Tara was an intelligent woman, and I knew she’d appreciate understanding a little more about the vast complexity of our bodies, and how numerous processes can affect our mental health. “Tara, inside your body there are 32 trillion cells, and inside each cell there are up to 2 trillion molecules. And inside your brain there are 200 billion neurons that connect across 40,000 trillion synapses. All of these molecules, cells, and connections comprise a grand symphony orchestra that deeply affects how you feel and function, and the composer and conductor of this miraculous orchestra is your DNA. With a simple cheek swab we will analyze your personal DNA and use it as a roadmap to help restore your mental health. I promise.”

One week later we met to review her genetic testing results. “Tara, the conductor of the grand symphony inside you is suffering from several maladies, and as a result her compositions lack harmony, and are increasingly discordant. Let me explain.” Tara had variants in her SLC6A4 gene (thus the poor response to three different SSRIs), CACNA1C and ANK3. As a result, I recommended that she go on Trintellix and Lithium. Tara was shocked and appalled. “Dr. Kehr, that will never happen! I thought you were going to put me on some supplements. My family will never accept my need for multiple psychiatric medications. They will see me as weak, as a failure, as a disgrace to our storied ancestry. Besides, isn’t lithium used for psychotic people? Are you saying that I am psychotic?”

I empathized with her distress, and patiently explained each of her genetic variants, and how they, along with her job stress and family relationship challenges, had served to bring about her depression, and how my medication recommendations addressed each of her variants. Tara took a medical leave of absence from work, we started the recommended regimen, and she began to improve.

We also uncovered a latent ADHD in her, which had been masked for many years by her high intelligence. Her processing capacities had become overwhelmed by the information processing demands placed upon her at work. We instituted Vyvanse to help these symptoms and she began to further respond to treatment.

In psychotherapy we began to explore the origins of her relentless drive toward stardom, and the enormous price it was exacting on her mental and physical health, and relationships with her husband and friends. We explored her troubled relationship with her father and the origins of her intense yearnings and longings to please him, and be just like him.

In time, Tara was able to sit down with her father and let him know that she was not him—that due to her genotype she was “an Orchid”—less resilient, more vulnerable to certain contexts and cultures, and as a result of her personal genome she had to seek out a less stressful position at a smaller, lower profile firm. She let him know, “It’s not me, Dad, it’s my genes that make me this way.” Somewhat surprisingly, this rigid and demanding man began to soften. He had known of friends whose families had “cancer genes” that had predisposed them to cancer, and conceptualized Tara’s “brain genes” accordingly. He embraced her after their conversation, and she wept tears of relief as she told me.

It is now one year after we began her medication, and Tara is almost fully mended. She left the high-pressure job and took a series of smaller consultancy gigs. She spends more time with her husband and their two cats and their flower garden. We are still working together to help her discover what comes next. What will be a better fit for Tara, and her personal genotype? For the first time in Tara’s life, the possibilities seem endless.

Help others. Please click the social buttons below to share these weekly insights with those who may benefit.

National Genetic Testing and Second Opinion Consultations

If you would like to feel well and recover your health, make an appointment for DNA Testing  or request a Second Opinion from Potomac Psychiatry.

Read my Amazon Best Seller Book,  ratings on Amazon and Goodreads,  Becoming Whole: A Healing Companion to Ease Emotional Pain and Find Self-Love, if you would like to feel better through genetic testing, and improve your love relationships.

Proceeds from your purchase of my book will be used to directly help rape survivors and victims of child abuse through donations to RAINN

*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)

DISCLAIMER

The post “It’s Not Me, Dad, It’s My DNA”: How SLC6A4, CACNA1C, and ANK3 Genes Restored a Father’s Respect appeared first on drbrucekehr.com.

Read Full Article
  • Show original
  • .
  • Share
  • .
  • Favorite
  • .
  • Email
  • .
  • Add Tags 

Reader, what does your life look like when you’re feeling mentally healthy and well? Perhaps it means waking up every morning with a clear mind and a contentedness as you start the day. Perhaps it means you’re taking the stressors in your life in stride, rather than being knocked down by them. Maybe mental health in your life means you’re drinking less alcohol and eating better—maybe it means you’re connecting with loved ones, and even finding your own inner spiritual peace. Now, consider the opposite question: What does your life look like when you’re feeling mentally unhealthy and unwell? Perhaps it means you’re self-medicating or lashing out in passive aggression or anger. Perhaps it means something more serious, like self-harm or a bipolar depression episode. For many, our mental health shifts subtly week by week, month by month until it reaches a crisis point. But sometimes, reader, you just feel stuck—you’re mentally unwell and maybe you have felt this way for years, yet you have absolutely no idea what to do about it—or whether a solution exists at all. Sometimes, this “stuck” feeling leads patients into their first therapeutic experience. Many of my patients have seen therapy as  a last resort in dealing with this “stuck” feeling; many even come to see me at the behest of loved ones who just can’t take seeing them in so much emotional pain anymore. But what happens if you’ve been in treatment, yet still feel that awful “stuck” feeling, even after a trial of one or more medications and talk therapy? What happens when your last resort… doesn’t work?

Reader: every single one of us deserves to live a healthy, whole life. In fact, it is our birthright. The goal of therapy is to help patients access that wholeness to Become Whole —and that can take time, investment, and patience. It may also require getting a second opinion including genetic testing. Today, I want to take you on a journey into the therapeutic process of a woman named Adele.* After months of psychotherapy and medication, she wasn’t getting better. But instead of giving up, she went deeper.  Adele’s story is one of perseverance—and one that I hope will encourage you to stick with therapy until you become whole, too.

The SLC6A4 “Orchid Gene” and Childhood Trauma in an Adult Woman

Adele* was a young mother in her early thirties with a brilliant mind and promising career. She held a master’s degree in engineering as well as a law degree, and was highly valued as a patent lawyer at her law firm. Like so many of my patients, to the outside world she seemed to have it all. Yet when she came to see me, she told me in no uncertain terms she was actively considering ending her life. She had been referred to me for a second opinion by her primary care doctor, as she was not feeling or functioning well on the medication regimen prescribed by her current psychiatrist. She was also in weekly psychotherapy with a psychoanalytically-oriented psychotherapist but felt too impaired to use the therapy effectively. In other words, she was stuck—and dangerously so.

At our first session, Adele described through her tears a long and complicated history. However, an overarching theme began to emerge: She felt she was living a “scripted life,” one that was written for her but not by her. Nothing in her life felt right. “Dr. Kehr,” she said tearfully, “I am just not sure I want to go on living. I have no hope for ever recovering. I just feel so vulnerable all the time. I feel terribly sick, yet medications only seem to make me worse. I am at the end of the line.”

I didn’t know it yet, but Adele would turn out to be what I think of as a highly complex “Orchid.” You might remember from my prior blog post on the topic that a variant on your SLC6A4 gene may have a bearing on your levels of resilience: some gene variants allow individuals to persevere through challenges with relative ease—while other gene variants can make these same challenges more difficult to overcome. The knowledge and insight of one’s genetic makeup, paired with the personalized precision care that genetic testing facilitates, can have a major impact on “Orchid” types like Adele.

Several years before I began treating her, Adele was diagnosed with postpartum depression following the birth of her daughter, Susan. But her history with depression had begun well before that. Adele grew up in a household that had lacked emotional warmth. Her mother was demanding, histrionic, and never satisfied with life or anyone around her; her father was emotionally distant. Her mother created in Adele a feeling of helplessness, as she could never predict when her mother would erupt in tears or anger, or level scathing criticisms toward her. This type of toxic behavior didn’t end in childhood—in fact, it persisted in her mother as Adele and I began our work together. Adele never felt emotionally safe or comfortable around her. To complicate matters further, Adele had been repeatedly sexually abused between the ages of six and nine by her father. There couldn’t have been a worse childhood environment for this “Orchid.”

The CACNA1C “Roller Coaster Ride Gene” Stabilized by Three Medications

Adele had been on medication for a significant period of time—but a major factor of her feeling at her wit’s end was that her prescription didn’t seem to be helping. In fact, it seemed to make things worse. Following initial treatment with an SSRI antidepressant by an earlier doctor she had seen, she began to feel she was increasingly out of control of her emotions. She developed racing thoughts, increased anxiety, and sleeplessness which at the time were attributed to her being a new mother. However the symptoms began to worsen and included irritability, anger outbursts, frequent migraine headaches, impaired concentration and executive functioning, excessive spending, despair and feelings of hopelessness, and a variety of unusual sensory experiences. Suffice it to say, her daily life could be characterized as an extremely painful “roller coaster ride.”

While Adele had been in psychotherapy for the past several years to work through her having been sexually abused as a child, and the therapy was proceeding well according to her and her therapist, Adele began to experience what she described as episodes where she felt disconnected from others around her—including her baby daughter. She described these episodes as her “spells.” Her condition had further deteriorated to the point where she was unable to work, and she arranged for a prolonged medical leave of absence from her law firm to attempt to regain her health. To complicate things further, Adele had gained a substantial amount of weight as a result of the pregnancy—60 pounds—and had only been able to lose 20 of those pounds in the two years since she gave birth to Susan. Despite her youthful age, Adele presented with many of the symptoms of an unhealthy 80 year old, for in addition to her unstable mood disorder and gazing spells, she suffered from weight gain, gastrointestinal complaints, nausea, muscle and joint aches and pains, deficits in attention and recent memory function, fatigue, and a pervasive inability to concentrate.

At the end of our first session I said to her, “Adele, your story is a sad one, yet it is also filled with hope. Despite growing up with two disturbed parents, and being subjected by them to horrible emotional and sexual abuse, you survived your childhood, and your courage, intellect and drive helped you to become a highly respected attorney; and your capacity to love others, which is remarkable given the circumstances of your childhood, has enabled you to create a beautiful family with a loving husband and a lovely baby girl. Your medical situation is a complicated one, and it would appear that the antidepressant you are taking is worsening your underlying condition. We will begin to modify the underlying biological processes going on in your brain to help you feel better and function more effectively. I am confident I can help you—and I’m proud of you for not giving up.”

To provide her a personalized precision psychiatric approach, we performed Genomind’s Genecept and Mindful DNA Assays through two simple cheek swabs. The results uncovered genetic variants in Adele’s SLC6A4, CACNA1C, COMT, MTHFR, BDNF, ABCA7, CD33, CHRNA5/3, FTO, LRP1, PPARG, FKBP5, HLADQB1, and CRP Genes. Armed with this information, we embarked on a thoughtful, persistent, progressive approach to restore her health.

The first step was to stabilize her unstable mood disorder, which was complicated by her extreme sensitivity to medications; and to determine whether her sensory illusions and “spells” resulted from childhood sexual abuse (perhaps a type of dissociation) or temporal lobe seizures. She initially responded to low doses of Lamictal (an antidepressant and mood stabilizer that downregulates the effects of CACNA1C gene expression) as we weaned her off the SSRI. You may recall from my prior blog on CACNA1C that variants on this particular gene play a role in the way our bodies regulate our emotions. Some variants make it much harder for us to “come down” from an emotional high, and leave us stuck on that emotional roller coaster ride for far longer than we’d like. She began to improve somewhat, but her moods remained unstable. We then added another calcium channel blocker, Nimodipine, which provided further stabilization.

Adele’s cognitive functioning remained quite impaired, so we added Namenda (this calcium channel blocker is a fascinating medication: it was first used to help slow the progression of Alzheimer’s Disease and has recently been shown to provide mood stabilization and improved cognitive functioning in patients with bipolar disorder as well). Namenda began to help further stabilize her mood and improve her anxiety levels while also improving her cognitive functioning.

The MTHFR “Neurotransmitter Manufacturing Gene”, the COMT “Dopamine and Norepinephrine Depleting Gene”, and the BDNF “Brain Fertilizer and Resilience Gene” Stabilized by Supplements and Medication

When individuals are treated for mood disorders, the underlying problem often lies with three key neurotransmitters: serotonin, norepinephrine, and dopamine. The abundance of these chemicals in the body are absolutely critical in mood and anxiety symptom improvement. And they also happen to be regulated by the MTHFR gene. In my prior blog, I dubbed the MTHFR gene the “manufacturing gene”, and for good reason: depending on your gene variant, your body will naturally produce more of these neurotransmitters—or less. Adele’s body was producing less. Adele’s low levels of dopamine and norepinephrine were also caused by a Val/Val variant on her COMT gene. To help her body naturally produce more of those crucial chemicals, we began her on Methylfolate.

BDNF is another gene crucial to the production of critical neurotransmitters—I call it the “fertilizer gene.” Recall from my prior blog that this gene promotes the survival and growth of brain cells and connective synapses, and helps your body to produce those critical neurotransmitters that stabilize your mood.  Adele’s brain’s resilience to stress was impaired by her BDNF gene variant, so we added L-theanine to boost these important neurotransmitters further, and improve the resilience of her brain cells and synaptic connections. Modafinil further increased her frontal lobe cognitive functioning by increasing dopamine and norepinephrine levels.

A Medical Workup to Address the Effects of ABCA7, CD33, CHRNA5/3, FTO, LRP1, PPARG, CHRNA5/3, FKBP5, HLADQB1, and CRP Genes

Adele’s other genetic variations placed her at higher risk for dementia, elevated stress response, migraine headaches, metabolic syndrome (obesity, type 2 diabetes, high blood pressure, elevated cholesterol), and celiac/gluten sensitivity, narcolepsy, and systemic chronic inflammation and autoimmunity. This may sound like quite a lot, but the important thing to keep in mind is that lifestyle modifications and prescription medication when needed can target every single one of these issues—and genetic testing is what allows for the level of specificity and precision that produces results over time.

We arranged for a neurology workup including a sleep study, a 48 hour EEG, which revealed some focal cortical irritability in the left temporal lobe; and extensive blood work, which revealed low levels of thyroid hormone, insulin resistance, excess cholesterol, several vitamin deficiencies, elevated inflammatory biomarkers indicating generalized increased inflammation throughout her body, and gluten sensitivity. It was obvious from these test results that there were a number of epigenetic factors that were negatively affecting her mood and thinking, and so we developed a stepwise interventional strategy to address each of them that involved a gluten-free Mediterranean Diet, thyroid hormone replacement, Vitamin supplements, rotation of three different probiotics, and Curcumin to reduce inflammation. She also began working out with a personal trainer and pursued an exercise program three days per week.

Reaching Wholeness Again… Whatever it Takes

Slowly but surely this regimen began to improve her mood, outlook, cognitive functioning, and energy level. By the end of the first year she had improved about 80% and felt hopeful for the first time in several years. Her psychotherapy was going better as she now had enough energy to face the intensely painful feelings and memories associated with having been abused. She learned how to set effective limits on her mother, improve her relationship with her husband, and find a lower-stress legal job, all of which helped this lovely orchid woman begin to grow and thrive once again! Low and behold, after about two years of treatment, the effects of these stepwise and complex interventions, while not miraculous, restored Adele to over 90% return of her baseline functioning.

“Adele, we have made tremendous progress working together. I am so happy for you. You are finally at the point where you can work far more effectively in your talk therapy, to hopefully resolve once and for all the abuse you sustained as a child; and through returning to work in a more nurturing work culture you can begin to restore your professional identity, one for which you worked so hard for so many years. Hopefully your success as a wife, mother and attorney; along with the strong bond you have with your psychotherapist; will enable you to finally resolve the conflicts that you have carried inside of you for so long.” She wept tears of joy, and I thanked her for being so diligent in working with me in a true partnership on this long and winding road to recovery.

While Genetic testing is no “Magic Bullet,” the lesson here is that through a personalized, precise, and persistent treatment plan; guided by one’s personal genetic variations; a number of the epigenetic stressors that perpetuate and worsen a patient’s mood disorder or anxiety can be systematically addressed and corrected.

Adele, who once felt hopelessly ill, had her hope and health restored. Reader, if you stick with treatment and work with your doctor to understand your underlying genetics, there is hope for you, too. Don’t give up!

Help others. Please click the social buttons below to share these weekly insights with those who may benefit.

National Genetic Testing and Second Opinion Consultations

If you would like to feel well and recover your health, make an appointment for DNA Testing  or request a Second Opinion from Potomac Psychiatry.

Read my Amazon Best Seller Book,  ratings on Amazon and Goodreads,  Becoming Whole: A Healing Companion to Ease Emotional Pain and Find Self-Love, if you would like to feel better through genetic testing, and improve your love relationships.

Proceeds from your purchase of my book will be used to directly help rape survivors and victims of child abuse through donations to RAINN

*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)

DISCLAIMER

The post <h2>OMG!</h2> <h3>How SLC6A4, CACNA1C, COMT, MTHFR, BDNF, ABCA7, CD33, CHRNA5/3, FTO, LRP1, PPARG, CHRNA5/3, FKBP5, HLADQB1, and CRP Genes Predicted Treatment Response</h3> appeared first on drbrucekehr.com.

Read Full Article
  • Show original
  • .
  • Share
  • .
  • Favorite
  • .
  • Email
  • .
  • Add Tags 

Reader, the media has generated a lot of speculation recently about the potential consequences of building a wall between the US and Mexico. In the last few weeks, President Trump has even considered shutting down the entire border between the two countries. One consequence has garnered intense bipartisan concern, and may even reach a crisis level: the possible impact a border shutdown would have on this country’s love of (of all things) avocado! In the last decade, Americans’ consumption of avocados, and subsequently its delicious biproduct, guacamole, has increased drastically.  As such, some estimates have projected that guacamole supplies could run out in less than a month after shutting down the supply line.  Now, I’m not here to jump into the political battle that surrounds the debate over the wall or the shutdown. Instead, I want to offer you some food for thought on how this potential supply chain issue is eerily similar to the physiological limitations that certain genetic variations can cause in our body.

Supply chain constraints on the avocado market would inevitably lead to critical scarcity in the guacamole market. Now, those with a particular passion for guacamole may argue this delicious food is essential to feel well. While we might empathize with their passion, today, we’re going to talk about a few mood-regulating chemicals that are truly essential—yet very much reliant on your body’s supply chain to show up and make an impact. Serotonin, norepinephrine, and dopamine are known as the “feel good” chemicals that stabilize your mood, are responsible for your joy, and promote general feelings of wellbeing and contentment. But, like guacamole, these chemicals are reliant on a critical “ingredient” in order to be produced and reproduced. The gene fundamental to their production line is called Methylenetetrahydrofolate reductase (MTHFR).  I am excited to welcome back my child and adolescent psychiatrist colleague at Potomac Psychiatry, Mark A Novitsky Jr. MD, to share with you more information about MTHFR and how it is essential for wellness—especially in children!

Why MTHFR Production May Hold the Key to Your Child’s Happiness

The production of MTHFR plays a critical role for a child’s wellness—and abnormalities can cause negative consequences both physically and mentally.   This gene codes for an enzyme that converts Folic Acid/Folate (a B vitamin) into the active form, L-Methylfolate.  L-Methylfolate is then used as a cofactor for the production of the neurotransmitters serotonin, norepinephrine, and dopamine.

Many individuals in the population may have one or more genetic variants of MTHFR, so having a variant doesn’t necessarily mean that you will have clinical consequences. However, as an individual has more variant genes, the consequences add up and the likelihood of neurotransmitter production constraints increases.  Like a wall or border shutdown blocking avocados entering the US, these variants limit the availability of L-methylfolate in the body.  Similar to the effect of a limited supply of avocados on the guacamole market, an underproduction of  l-methylfolate results in a deficiency of serotonin, norepinephrine, and dopamine—ultimately resulting in anxiety, depression, memory issues, inattention, hyperactivity, and impulsivity.

For this reason, when a child comes to me for psychiatric treatment, I recommend that we do genetic testing to give us an idea of a child’s baseline genetic supply lines.  As I shared previously in Dr. Kehr’s blog series, genetic testing has helped me to limit the number of medications that I have prescribed—often through optimizing MTHFR.

The Benefits of MTHFR Genetic Testing: Mood Elevation, Reduced Anxiety, and More

Traditionally, psychiatry has “medicated” a child’s underproduction of Serotonin through the prescription of SSRI antidepressants (Selective Serotonin Reuptake Inhibitors such as Prozac, Lexapro, Zoloft, Celexa, Paxil, etc.) and the underproduction of Norepinephrine with SNRIs (i.e. Cymbalta and Effexor) in hopes of elevating mood and mitigating anxiety.  These medications, while necessary in many cases, do carry an FDA black box warning for increased suicidality with youth, so if there is a way to avoid having to use them—or to limit the dosage needed—I pursue that path first.  Similarly, the ADHD stimulant medications (i.e. Adderall and non-stimulant ADHD medication Strattera) have traditionally been used to account for the underproduction of dopamine but often lead to decreased appetite, insomnia, and irritability after the medication wears off.

In certain cases, if the genetic variants (sometimes called genetic mutations) are significant enough, I compensate for the body’s inability to generate enough L-Methylfolate and encourage families to first consider supplementing with L-Methylfolate rather than the traditional vitamin Folic Acid, which the child’s body cannot adequately utilize.  This enables the production line to maximize the production of serotonin, norepinephrine, and dopamine.  There have been several cases where a child’s anxiety, mood, and focus have seen improvements with this intervention alone, obviating the need for prescription medication altogether.

For others, by increasing production of neurotransmitters, it allows medication interventions to be more effective.  For example, in the case of using an SSRI in a depressed child (assuming the SLC6A4 gene recommends use of an SSRI in a depressed child), the increased production of Serotonin results in an increased amount of serotonin in the presynaptic neuron (brain cell).  The presynaptic brain cell releases serotonin with a goal of it reaching the second neuron, the post synaptic neuron to “feel” the effect of serotonin.  The body is pretty good at cleaning up after itself, so the presynaptic neuron takes back (“reuptakes”) any unused serotonin. SSRI antidepressants work by blocking this reuptake, thereby allowing the serotonin more of a chance of getting to the ultimate target.

Increasing the arsenal of serotonin through MTHFR allows for more serotonin to be en-route to the target to elevate mood and reduce anxiety, and thus allows for the SSRI to be more effective even at lower doses (thereby limiting the risk of unwanted side-effects).  The same can be said for dopamine and limiting stimulant doses.

Long story short, we don’t need for genetic obstructions to limit production if we are aware of the work-arounds.  Now if only we could figure out a solution for the potential avocado shortage!  My Chipotle Burrito bowl just won’t be the same without that generous heap of guacamole…

Help others. Please click the social buttons below to share these weekly insights with those who may benefit.

National Genetic Testing and Second Opinion Consultations

If you would like to feel well and recover your health, make an appointment for DNA Testing  or request a Second Opinion from Potomac Psychiatry.

Read my Amazon Best Seller Book,  ratings on Amazon and Goodreads,  Becoming Whole: A Healing Companion to Ease Emotional Pain and Find Self-Love, if you would like to feel better through genetic testing, and improve your love relationships.

Proceeds from your purchase of my book will be used to directly help rape survivors and victims of child abuse through donations to RAINN

*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)

DISCLAIMER

The post Holy Guacamole! The MTHFR Gene and the Avocado Shortage appeared first on drbrucekehr.com.

Read Full Article
  • Show original
  • .
  • Share
  • .
  • Favorite
  • .
  • Email
  • .
  • Add Tags 

Dear Reader, in the wake of the 2019 College Admissions Scandal, better known as “Operation Varsity Blues”, the tabloids depicted the great lengths that parents will go to in order to give their children “an edge” by getting them into prestigious universities. These parents spent $25,000,000 dollars to get the results they wanted. But what if I told you about a quick and easy way to maximizing your child’s future potential that doesn’t involve bribery or deception—and won’t empty out your bank accounts either? Believe it or not, a simple cheek swab can unlock your child’s unique genetic code, including a gene critical in memory formation, comprehension, optimizing mood, and maintaining appropriate weight—Brain Derived Neurotrophic Factor, better known as BDNF.  With enthusiasm, I welcome back to this blog series my colleague and friend, child psychiatrist Mark A. Novitsky Jr., M.D., to share with you more about this exciting gene …

BDNF: A Genetic Key to Your Child’s Success

“Perhaps there is no gene more essential to your child’s developing mind than the one that codes for Brain Derived Neurotrophic Factor (BDNF).  The very word “Neurotrophic” derives from the ancient Greek—neuro and trophic—meaning “brain” and “growth”, respectively.  BDNF promotes the growth and survival of your child’s brain cells by improving executive functioning, enhancing memory, and producing the neurotransmitters that are critical for optimizing mood.

Every day, your child’s brain develops new brain cells, called neurons.  I’ve previously likened BDNF to the nutrient rich fertilizer that help these neurons grow.  Moreover, BDNF can help existing neurons to branch out and communicate with other brain cells.  This increased connectivity is critical in new memory formation, and this anatomical explanation is not too far off from the commonly used term “connecting the dots” that occurs when a child masters new concepts.

Genetic testing for BDNF can help parents and clinicians to determine a child’s genetic baseline for BDNF production.  While some children are pre-wired to produce high levels of BDNF, others inherently make less.  The good news for these children who have inherited a genetic predisposition for a low level of BDNF is that they can use this knowledge to make important lifestyle interventions to overcome this potentially negative predisposition.

Most importantly, parents and practitioners can encourage these children to maintain exercise routines and thereby dramatically enhance BDNF levels and subsequent brain growth.  Families can work with pediatricians to adjust a child’s diet to increase BDNF.  Certain diets, such as the ketogenic diet has been shown to improve BDNF levels.  Certain supplements, such as omega 3 and microdose lithium (one thousandth the dose we prescribe to treat mood disorders), can also increase BDNF.

Can Genetic Testing for BDNF Change a Child’s Future? Taylor’s Story

Let me share with you a recent success story that resulted from using genetic testing for BDNF and demonstrates the gene’s powerful impact.

Taylor* is a 13-year-old girl who presented to me for a second opinion.  She had previously seen her pediatrician for an assessment of ADHD after her family had noted some difficulty with focusing in class that had worsened when she entered middle school.  Looking back, her mother reflected that Taylor had always had some problems with inattention, but between the accommodations that her parents arranged for her at her school, including sitting close to the front of the class and organizing homework schedules, she had generally maintained good grades.  Her pediatrician first treated her with low dose Adderall (an ADHD stimulant medication) but this caused severe anxiety.  Subsequently, an alternative ADHD stimulant, Ritalin, was prescribed and she had a similar negative experience.  She was referred to a psychiatrist who prescribed her a non-stimulant, Strattera, which was well tolerated but had limited effectiveness.

Taylor and her family came to me for a second opinion.  Several minutes into our first session, Taylor’s mom made it clear that she and Taylor were skeptical of potential ADHD medications, given her past experiences.  Understandably, they were frustrated with the trial and error approach to medicating Taylor.  I encouraged them to let Taylor’s unique genetic profile help dictate our treatment approach, something we call personalized precision psychiatry.  Taylor and her mother had never previously heard of genetic testing but were excited to take the guessing-game out of the traditional psychiatric treatment she had already received.

After a painless cheek swab, Taylor’s genetic testing results elucidated that she was extremely sensitive to excessive dopamine.  Further treatment with any alternative stimulant medication would result in anxiety.  The non-stimulant approach with Strattera was confirmed as an appropriate medication, but clearly it was not enough.  Even on the Strattera, she found herself staying up late to finish homework.  Taylor’s mom regretfully informed me that she had even given up gymnastics earlier in the year just to appropriate more time for studying.  In theory, this made logical sense, however, her genetic test results for the BDNF gene proved otherwise, demonstrating a genetic variation that would underproduce this critical “brain fertilizer,” all the more so when under stress.

We put together a holistic treatment plan for Taylor.  She restarted gymnastics and ran on the treadmill faithfully every morning.  We discussed sleep hygiene and ensured that she was getting an adequate amount of sleep.  She made some dietary adjustments and ate a modified ketogenic diet.  Three months later, Taylor and her mom entered my office.  She was bright, energetic, and proudly shared her recent report card.  She and her mom couldn’t believe how much of a difference these lifestyle changes made in her well-being.  One thing they did believe in was the utility of genetic testing—and the importance of the BDNF gene.

***

Embracing its mantra of “Whatever It Takes Medicine”, Potomac Psychiatry is a pioneer in incorporating genetic testing and integrated psychiatric treatment to deliver personalized precision psychiatry. We’ve used Genomind’s genetic tests for the past six years, in the evaluation and treatment of more than 1400 of our patients. And Dr. Kehr’s numerous blogs about genetic testing have been read by well over 300,000 visitors.

Help others. Please click the social buttons below to share these weekly insights with those who may benefit.

National Genetic Testing and Second Opinion Consultations

If you would like to feel well and recover your health, make an appointment for DNA Testing  or request a Second Opinion from Potomac Psychiatry.

Read my Amazon Best Seller Book,  ratings on Amazon and Goodreads,  Becoming Whole: A Healing Companion to Ease Emotional Pain and Find Self-Love, if you would like to feel better through genetic testing, and improve your love relationships.

Proceeds from your purchase of my book will be used to directly help rape survivors and victims of child abuse through donations to RAINN

*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)

DISCLAIMER

The post Maximize your Child’s Potential with the BDNF Gene appeared first on drbrucekehr.com.

Read Full Article
  • Show original
  • .
  • Share
  • .
  • Favorite
  • .
  • Email
  • .
  • Add Tags 

Dear Reader, if you have been following the news over the last few weeks, you are well aware of the challenges that parents are facing in protecting the innocence of their children.   A pediatrician from Florida uncovered disturbing hidden messages in online programming typically catered towards young children, including instructions on how to kill yourself.  While some have claimed it to be a hoax, the viral ‘Momo Challenge’ reportedly scared children into committing suicide, causing many schools across the country to send home precautionary warnings reminding parents to closely monitor children’s online viewing.  The Momo Challenge is just one of many terrible features of the news cycle this week—and even if the Challenge is a hoax, other stories are horrifically real. Detailed documentaries emerged of celebrities reportedly sexually abusing minors, the first featuring graphic allegations of sexual abuse of underage females by R&B artist R. Kelly—and more recently, two men and their families depicting the paralyzing effects of alleged sexual abuse by the late pop music superstar Michael Jackson.   Like many of my patients who are parents, you may be wondering how we can keep our kids safe from these real dangers and what factors might help us to assess and improve upon their resilience in the light of such atrocities.

Is Your Child an “Orchid” or a “Dandelion” when Subjected to Traumatic Experiences?

I have asked my valued colleague and friend, child psychiatrist Mark A. Novitsky Jr., M.D., to weigh in on childhood trauma and how genetic testing might help us to understand the impact that it can have on the growth and development of our children. As it turns out, one gene in particular, the SLC6A4 gene, may hold some important insights…

Could the SLC6A4 Gene Determine How Your Child Reacts to Trauma?

Welcome back Readers!  Last week, we discussed the importance of the SLC6A4 gene in choosing an appropriate antidepressant medication when treating depressed or anxious youth. However, over the last several years, new research has emerged to suggest that the importance of this Serotonin Transporter (SERT or 5-HTT) gene, extends far beyond choosing a course of treatment.  Today, we will discuss one powerful implication of SLC6A polymorphism: susceptibility to PTSD and depression in the face of trauma.

What we are really talking about here is altered stress response based on whether you have an SLC6A4 gene with short alleles (s/s), long alleles (l/l), or a hybrid (l/s).  If you are a faithful reader of this blog like myself, you will recall Dr. Kehr’s elegant analogy of SLC6A4 variants as “orchids” or “dandelions” in the face of stress, noting that it’s our stress-response genes that determine which category we fall into. Individuals with two short alleles the SLC6A4 gene, when subjected to trauma, have increased serotonin in the amygdala, the fear-response center of the brain.  This results in a higher likelihood of experiencing fear, greater release of cortisol, and ultimately potentially higher rates of anxiety and depression.

Much like the orchid flower, children with potential vulnerability (ie s/s genotype) flourish in a low stress, nurturing environment.  “Dandelion” children (i.e. l/l genotype), on the other hand, are genetically better equipped to handle high-stress environments—like trauma.

Can You Change Your Child’s Genetic Destiny by Switching a Gene On or Off?

Now that you understand your child may be genetically predisposed to handle traumatic environments in a certain way, you may be wondering what, if anything, you can do to bolster your child’s resources. As Dr. Kehr says, DNA does not have to determine your destiny—and indeed, you can help alter your child’s genetic fate. Even though an individual may be more like that “orchid” (i.e. s/s), there are innumerable “epigenetic inputs” that can tell your body to switch “on” or “off” certain genes.  In the case of trauma, the most valuable way that you can affect your child’s outcome is to provide a nurturing, non-judgmental environment.

In much the same way that a child with a broken bone may require a cast to prevent further damage and allow time for healing, it is critical for a child who opens up about trauma to experience emotional support to avoid further traumatization and start the healing process.  What many parents don’t realize is the first critical step in the process toward healing happens the instant a child brings up a traumatic experience—and this often occurs well before a child presents for therapy. Sadly, it is not uncommon for a parent to initially deny that the trauma could have occurred or blame a child for putting themselves in that situation.  It is important to recognize that a parent’s initial reaction can affect how a child’s body switches genes “on” or “off” at that very moment.  Failure to empathize and provide support increases the likelihood of long-term devastating effects of trauma, including anxiety, depression, and suicidal behaviors.

Alternatively, providing a nurturing environment at home, in school, and through therapy can ensure a vulnerable “Orchid” can get the right mixture of “temperature, humidity, and nutrients” to not only persevere through the trauma but ultimately grow to be a strong, beautiful, resilient flower.

Help others. Please click the social buttons below to share these weekly insights with those who may benefit.

National Genetic Testing and Second Opinion Consultations

If you would like to feel well and recover your health, make an appointment for DNA Testing  or request a Second Opinion from Potomac Psychiatry.

Read my Amazon Best Seller Book,  ratings on Amazon and Goodreads,  Becoming Whole: A Healing Companion to Ease Emotional Pain and Find Self-Love, if you would like to feel better through genetic testing, and improve your love relationships.

Proceeds from your purchase of my book will be used to directly help rape survivors and victims of child abuse through donations to RAINN

*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)

DISCLAIMER

The post Genetic Susceptibility to Childhood Trauma in the Age of Momo from the SLC6A4 “Orchid Gene”<br><br>Well-Informed Parenting through a Simple Cheek Swab appeared first on drbrucekehr.com.

Read Full Article
  • Show original
  • .
  • Share
  • .
  • Favorite
  • .
  • Email
  • .
  • Add Tags 

“The blood of your parents is not lost in you.

       –  Menelaus, The Odyssey, 8th century BC

Dear Reader, perhaps like many of my patients who are parents, you wonder whether genetic testing might help your child become more resilient, or help them feel better about themselves and their lives, or function more effectively at school? Today, we will begin to answer those questions with our new series on the use of Genetic Testing in the evaluation and treatment of Children and Adolescents.

I am delighted to welcome once again my esteemed colleague and friend, child psychiatrist Mark A. Novitsky Jr., M.D., who will share his perspective throughout this series…

If you are like the majority of the parents who bring your child to Potomac Psychiatry for an initial intake, the idea of starting your child on medication can be intimidating.  Perhaps you are being encouraged to meet with a child and adolescent psychiatrist by your child’s school staff, therapist, or pediatrician.  If this has been an ongoing problem that has recently worsened, you have likely already explored individual therapy and feel that you have exhausted behavioral/therapeutic interventions.  Sure, you can appreciate how any other child would benefit from medication—but, the idea of starting your child on medication… now that’s another story!

The well-informed parent that you are, you’ve probably already learned about the potential treatment options for your child’s problematic symptoms from “Dr. Google”—and possibly even read stories about all of the potential side effects that medications can cause.  You’ve done your homework and though you can hide it well, it is often a toss between who is more anxious in that first session with the Child Psychiatrist, your child or you. That’s where genetic testing comes in…  through the application of this pioneering biotechnology by a child psychiatrist experienced in its clinical use,  we can work to minimize the trial and error that comes to finding the right treatment. All through a simple cheek swab.

How Genetic Testing Can Ease the Stress of Medicating Your Child

To help make the prospect of medicating your child a bit less stressful, Potomac Psychiatry utilizes Genomind Genetic Testing.  Genetic Testing may sound a bit intimidating, but in reality, the test only takes about 30 seconds and is done right in our office.  There is no blood draw, no spitting in a test tube; it consists of a Q-tip gently rolling on the inside of each of your child’s cheeks.  That’s it.

After sending it off to the lab, within about a week we will have a Genetic Road Map of the genes critical to treating psychiatric conditions.  These results can help guide us to the most appropriate course of treatment, but testing alone won’t give us the “magic pill”.  That being said, it is an invaluable tool that gives us additional information to guide a potential treatment choice – combined with incorporating assessment of your child and all of the historical information that you’ve provided on your child in the initial interview.  For years I have shared with the parents of the children I treat, “You are the world’s expert on your child”.  But over the last few years, I have added the afterthought “… but DNA doesn’t lie.”

Embracing its mantra of “Whatever It Takes Medicine”, Potomac Psychiatry is a pioneer in incorporating genetic testing and integrated psychiatric treatment. We’ve used Genomind’s genetic tests for the past six years, in the evaluation and treatment of more than 1400 of our patients. And Dr. Kehr’s numerous blogs about genetic testing have been read by well over 200,000 visitors.

Not Every Child Needs Meds: How Genetic Testing Can Help Determine Alternative Routes for Feeling Better with No Medication Needed!

Though it may sound paradoxical, I have found that utilizing Genomind’s genetic tests has actually helped me to decrease the number of medications that I prescribe to children.  Why?  Because in addition to medication suggestions, these tests look at genes that are important in our body in regulating mood, anxiety, and focus, amongst other things.  In looking at your child’s unique DNA profile we may find supplements that can either directly treat your child’s presenting symptoms, or if taken with a medication, can increase the likelihood of that medication working (thereby limiting the need of additional medications).  More importantly, your child’s personal genetic road map may eliminate the likelihood of choosing an inappropriate medication that may lead to unwanted side-effects.  Unfortunately, it is not uncommon for a child to present to me for a second opinion or genetic test, and I find that they have been placed on a second or third medication just to counteract the side effects from the initial choice.

In a recent case, I saw a child, Jeremy*, who had been seeing another child psychiatrist for the last year.  He initially started treatment after his family noted increased irritability in the home, falling grades, withdrawal from his friends, worrisome posts on social media, and a decision to quit the school swim team (a sport that he was particularly good at and was potentially going to pay his way through college).  His treating child psychiatrist had appropriately diagnosed Jeremy with depression (in children irritability is often seen as the primary symptom rather than depressed mood)—and had started him on Prozac (Fluoxetine), an SSRI antidepressant that is the most studied antidepressant in children and FDA approved for this indication.  According the textbooks, this was the correct choice.  For the subsequent six months, the dose was slowly increased, yet Jeremy’s symptoms got worse.   Anger outbursts emerged and he had internalized that he was a bad child, often commenting that he wished he was never born.  Ultimately, after he relayed to a friend that he was thinking about hurting himself, the school counselor was informed, and Jeremy was sent to a partial hospital program.  While there, he was switched to an alternative SSRI antidepressant, Zoloft (Sertraline), and its dosage was slowly increased for the subsequent three months until his nausea was so great that they could not increase further. Eventually Abilify, an atypical antipsychotic medication that is often used for adjunct depression in adults, was added to his treatment.  He started to gain weight on this medication, so Topamax, an antianxiety medication that potentially causes weight loss, was added.  After a year of no improvement, and recent cognitive decline, he presented to my office in search of another opinion about how to help him.  Understandably, the family was skeptical of the efficacy of medications altogether—and had never heard about genetic testing, but at that point was willing to try almost anything to bring back the old Jeremy.

One week later, Genomind’s genetic test yielded a crucial finding:  variant alleles of SLC6A4.  SLC6A4 is the gene that codes the presynaptic transmembrane protein involved in serotonin uptake in the serotonin receptor.  In plain English, a backup at the serotonin receptor will result in less serotonin getting to the end target.  Less serotonin can result in depression and anxiety.

The concern in this case is that the two antidepressants he was prescribed, Prozac (Fluoxetine) and Zoloft (Sertraline) work by blocking the serotonin uptake.  Therefore, given his variant of two SLC6A4 short alleles, there is a higher likelihood that he would not respond to SSRI antidepressants – and moreover, that they would cause unwanted side effects.

Results of Genomind Genetic Testing suggested to avoid SSRIs and recommended several alternative options.  With some skepticism, he and his parents agreed to try a third medication option, (one from a different class of antidepressants), in fear that they would “waste another year” of Jeremy’s life.

I met with Jeremy last week for a medication check – these occur infrequently now that he’s been so stable – and he caught me up to speed with his latest swimming accomplishments and a copy of his straight A report card.  He’s referred a family member and several friends battling mental health concerns for genetic testing at Potomac Psychiatry, now that he’s a true believer.  Seeing may be believing, but feeling better is even more impactful.

DNA 4 KIDS with Dr. Mark Novitsky
GENiE, I wish to go on a Great Journey

Your wish is granted! In your body, you have an incredible network of roads called nerves. These nerves put together a complicated road map that allows information to travel great lengths from one part of your body to another.

Just as you would experience on a long trip, many of the roads in our body have certain toll booths where chemicals line up to get from one place to another. If you have ever travelled on one of the busier nights of the year (think about Sunday after Thanksgiving), you know that there can be a big difference in traffic between a road that has many toll gates open and one with just a few toll booth operators that seem to take forever with collecting money.

Serotonin, one of the feel-good chemicals in your body, uses a special toll booth made by the gene SLC6A4. The very purpose of this booth is to remove extra Serotonin off the road to avoid a traffic jam. These toll booths can be a target of medications that help kids who are anxious or depressed. They are particularly helpful for kids who are born with many functioning and efficient toll gates. For the kids who have SLC6A4 toll gates that might not work as well, it would be a good idea to think of a different route besides Serotonin to help them feel good. Genetic testing through Genomind can provide this important map to help you and your doctor figure out what the best directions are for your trip to feeling good. Buckle Up, and have a safe trip on your journey to feeling better!

Help others. Please click the social buttons below to share these weekly insights with those who may benefit.

National Genetic Testing and Second Opinion Consultations

If you would like to feel well and recover your health, make an appointment for DNA Testing or request a Second Opinion from Potomac Psychiatry.

Read my Amazon Best Seller Book, ratings on Amazon and Goodreads, Becoming Whole: A Healing Companion to Ease Emotional Pain and Find Self-Love, if you would like to feel better through genetic testing, and improve your love relationships.

Proceeds from your purchase of my book will be used to directly help rape survivors and victims of child abuse through donations to RAINN

*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)

DISCLAIMER

The post Can Genetic Testing Help My Child?<br><br>How a Simple Cheek Swab Provides the Answer appeared first on drbrucekehr.com.

Read Full Article

Read for later

Articles marked as Favorite are saved for later viewing.
close
  • Show original
  • .
  • Share
  • .
  • Favorite
  • .
  • Email
  • .
  • Add Tags 

Separate tags by commas
To access this feature, please upgrade your account.
Start your free month
Free Preview