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Glenn Yank, MD is a Psychiatrist located in Tennessee.


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Question:
I have serious DID and have integrated quite a bit through many years of therapy. However, we found that the various parts could have their OWN mental issues which they bring into the integrated mix. Now, the mixed parts (me) are dealing with hypomania, and schizoaffective problems, in addition to depression and dissociation. We have been on nearly every class of anti-depressant, anti-seizure, mood stabilizer, and most anti-psychotics, which either stopped working or caused serious side effects. However, the mood problems seemed to improve drastically when we started taking Enalapril for high blood pressure. We have given up on psycho-type drugs and manage in other ways. The question is, could Enalapril be helping, and if so, are there other high blood pressure drugs that have been known to help? Secondly, what is the best way to find a doctor who is willing work with someone who hasn’t been successful with any of the usual drugs? thanks, m

Answer:

First of all, I am glad something seems to be helping you. It is possible that Enalapril has helped you, although there is no evidence that I could find in the literature that Enalapril or other drugs in its class have any effect on mood. Enalapril is an ACE (angiotensin converting enzyme) inhibitor. This class of drugs inhibit the conversion of the protein angiotensin I to the angiotensin II, which causes blood vessels to constrict. ACE inhibitors may also effect the release of other chemicals that affect blood vessels, including norepinephrine and dopamine, which also function as neurotransmitters in the brain. The properties of norepinephrine and dopamine to work as both neurotransmitters and to constrict blood vessels is the reason that certain drugs used as stimulants, which act like these chemical and can cause their release from cells, can raise blood pressure as a side effect. In addition, angiotensin receptors have been found in the brain, and one small study showed that a different ACE inhibitor could help patients with Parkinson’s disease. This suggests that there is at least some interaction between angiotensin and dopamine in the brain. Thus, it is possible that the Enalapril may be helping your moods, although this cannot be proven.

There are other medications for hypertension that may be helpful for certain symptoms of post-traumatic stress disorder. In particular, anti-hypertensive medications that effect the chemical norepinephrine and its receptors may reduce the core PTSD symptoms of hyper-arousal. Beta-blocker drugs such as propanolol have been shown in some studies to block the re-emergence of PTSD symptoms after re-traumatization. The drugs clonidine and guanfacine (Tenex) have been shown to reduce startle responses in some patients. More recently, the drug prazosin has been shown in small studies to reduce nightmares, and is being studied to see if it has other helpful effects on PTSD.

Your last question is more difficult to answer, as there is no established way to find a doctor who is interested in “treatment resistant” patients, or who keeps up with the latest literature. I would ask any treatment providers that you know whom they might recommend, and I would also ask people you trust in local and on-line communities. Providers in university settings sometimes see it as part of their teaching responsibilities to stay as current as possible with the emerging treatment literature. Providers who participate in societies such as ISSD or ISTSS may do so because they are particularly interested in the emerging treatment literature regarding dissociative disorders and PTSD. But the key features of patience, curiosity, open-ness, and willingness to collaborate, which are needed to help someone who hasn’t responded to the usual drugs, are probably best found by asking people you trust, rather than looking for particular credentials. Good luck with your search!

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Disclaimer: The information contained here is not intended nor implied to be a substitute for professional advice relative to your specific medical or mental health condition or question. ALWAYS seek the advice of your physician or other health provider for any questions you may have regarding your medical or mental health condition. Information provided here DOES NOT constitute a doctor-patient relationship between you and the column author.

© Copyright 2003-2005. All rights reserved. Contact: ShrinkTime Last edited: 02/02/04.