Substance Abuse: Sandra’s Story

Sandra was a 34-year-old physician with depression and anxiety stemming from multiple stressors and losses. As with so many of us, her story of loss and depression begins in childhood. Sandra was a happy kid and an extremely good student with a great deal of ambition. But her life changed when, at age 15, her mother became ill with a fatal neurodegenerative disease. The disease progressed at an excruciatingly slow rate, leaving Sandra feeling completely helpless. It would be over ten years later before the disease finally claimed her. Sandra’s mother passed away the same year Sandra graduated with honors from a prestigious medical school.

During her mother’s illness, Sandra never found a way to cope with her substantial grief and trauma. Instead, she pushed her feelings down by throwing herself into her schoolwork. She also distracted herself from her overwhelming feelings by imagining herself in an ideal life—wealthy, powerful, and filled with the love of a man. When her mother finally passed away, Sandra kept her feelings to herself, focusing instead on her relationship with her boyfriend Sam, and on finding a job. Hired by a university hospital medical center in downtown Washington, DC, she immediately threw herself into her research, teaching and clinical responsibilities.  Several times a year she and Sam would vacation at exciting locales around the world as they were avid sailors and mountain climbers, always seeking out the next adventure. Eventually they became engaged to be married. That’s when her symptoms of anxiety and depression began to surface.

Sandra did her best over the next few years to continue to hide her deep suffering—even her husband had no idea what she was holding deep inside. When he took a job that kept him working well into the evening and on weekends, Sandra consoled herself by nights out bar hopping with friends in addition to her heavy workload. Soon, her nights out began to involve both alcohol and cocaine—and led to a series of extramarital affairs. Her habits were unsustainable—she was depleting herself at work, diving ever deeper into a substance abuse problem, and feeling unloved by Sam. Something had to give.

When Sandra first came to see me, she felt that if she began to cry—began to grieve her mother’s death—she would never stop crying for the remainder of her life. Since childhood Sandra had dreamed of a future free of the overwhelming pain that she felt inside, and we began to work together to facilitate her grieving, traveling down a long road to healing her broken heart. To help her use the talk therapy more effectively, it was important to simultaneously treat the biologic aspects of her depression.

Sandra’s psychological testing confirmed she suffered from both depression and ADHD—her genetic testing determined significant factors in her biological makeup, all of which could be addressed through prescription and non-prescription treatment. We began to treat her depression with Zoloft, as her genetic testing suggested she’d respond well to a regular SSRI. We addressed her ADHD with Vyvanse, and augmented both medications with Abilify. As her mood swings had become more severe, we placed her on an additional mood stabilizer, Lamictal (lamotrigine) that also had antidepressant effects, and began her on a prescription vitamin, l-methylfolate, that increased the manufacture of dopamine, norepinephrine and serotonin levels in the brain. These two medications were selected as a result of variants on her MTHFR and CACNA1C genes. The combination of several different medications to address dysfunctional circuits in her brain, combined with intensive psychoanalytic therapy, began to bring her the possibility of healing her fractured heart, and a future filled with more light and less darkness. Sandra was finally able to open her heart to her past—and she’s now doing better than ever.