So, why aren’t we looking for signs of high D2 dopamine in mentally disturbed patients? The answer is because most providers on the front line of mental health haven’t been trained to recognize it. Described in “Towards a glutamate hypothesis of depression,” (Neuropharmacology, Jan. 2012, page 62-67), D2 dopamine causes rage, impulsivity, and incongruency of thought. Sound familiar? The Glutamic Theory, as opposed to the fifty-year-old Monoamine Theory, perfectly describes the neurochemical scourge of symptoms in patients with elevated levels of D2 dopamine, including rage, hate, and other negative symptoms listed above. And since its entrance into the medical literature fifteen years ago, surely it must be the hitching post of modern psychiatry. One would hope so. But actually, it is not.
In the last fifteen years or so, I have taught more than one hundred-fifty medical and PA students in my office. When queried, not one of them had ever heard anything regarding the Glutamic Theory or D2 dopamine. That is pathetic and sad. And I would extend that nescience to the family practice providers and OBGYN’s that man the front lines of mental illness. The outdated monoamine theory just tells these practitioners to try a different serotonin drug, even though the previous ones have failed. Unfortunately, that is all they know. The Glutamic Theory has not made it into their respective medical literature.
Despite what the talking heads say, the problem with mental illness is not access to help. Access to what? Fifty-year-old theories? We need a revolution in psychiatry. First responders to mental health crises need more than a weekend crash course in neuropsychiatry. They need to understand D2 dopamine and how to recognize it. And one hundred percent of psychiatrists need to be on board with the Glutamic Theory, not the current thirty percent. Until then, thoughts and prayers are all we’ve got.
Dr. Rick Gebhart is an associate professor of medicine at Wright State University, Ohio State University, and Chamberlain University.