Even though there are many different avenues for biological intervention, there are many individuals that are hard – if not impossible – to treat. The following examples should illustrate how complex things can be. Often, it is not as simple as doing A, B, C, or taking X, Y, Z.
The case reports below only deal with the biological side of things. It is important to note that not every energy and mood-related problem can be attributed to a “brain disease” or primarily biological factors. With the following case reports I aim to demonstrate the complexity of things.
Some of the following examples were inspired by people I know, some by people I have read about, and others are entirely fictional.
Case A
A was a happy and energetic child but now she has problems with sleep, depression, and anxiety – despite being already on the highest therapeutic dose of escitalopram. A has taken a lot of MDMA in her early adulthood.
While the first couple of times were magic, it took her progressively longer to recover, until she did not anymore. An MRI scan shows no signs of pathological changes (but the degeneration of serotonergic nerve endings cannot be seen).
Case B
B always feels tired, cold, cannot lose fat, and has low energy levels. B has a mild form of panhypopituitarism due to an unrecognized traumatic brain injury as a child, which injured the axons making up the pituitary stalk.
He would benefit from the replacement of multiple hypothalamic hormones, though, his doctors never bother to look at them properly because they all came back in the low “normal” range.
Case C
Throughout his childhood, C was anxious and socially awkward. Even though he has now got a decent group of friends, the feeling that “something is missing” does not quite leave him. Unbeknownst to him, his mother was under major stress during pregnancy.
Consequently, the high levels of glucocorticoids exerted a disproportionately major influence on his brain wiring. Among other things, hypercortisolism led to significant differences in the cytoarchitecture and connectivity of his amygdalae, prefrontal cortices, anterior cingulate cortices, and insulae. These differences will persist throughout his life.
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Case D
D is impulsive, anxious, and prone to rage. To help him with wrestling in high school, D had dabbled in anabolic steroids. Not only did they stunt his growth, but certain emotional brain centers had wired differently compared to what they would have. Now he is permanently stuck with a “hyper-male” brain. And a hyper-hairy body.
Case E
E has a severe form of atypical depression, characterized by low energy levels, hypersomnia, and weight gain. For unexplainable reasons, the activity of his glutamatergic and monoaminergic systems has settled into very low attractor states and defies conventional treatment. Unfortunately for him, MAO inhibitors are not something most doctors are comfortable with, and therefore he never gets to try them.
Case F
Throughout his adolescence, F did so much exercise that he was constantly sore. Even though the underlying structural and chemical damage has long been repaired, F has focused so much on the pain, that the neurons and connections responsible for pain transmission have hypertrophied and strengthened respectively. He is now stuck with chronic pain that is “mostly in his head”.
Case G
G has taken SSRIs and reacted badly to them. After only a couple of days, he developed genital numbness, anorgasmia, anhedonia, and lethargy. Even after stopping, symptoms lingered on. He educated himself and tried out dozens of different treatments on his own. To no avail because his symptoms are caused by stubborn changes in gene expression complicated by serotonergic toxicity.
Case H
H is plagued by depression, anhedonia, a lack of motivation, derealization, and thought loops. All of these symptoms can be traced back to a time when H smoked weed a couple of times during a sensitive period of brain development. This has resulted in widespread aberrant synaptic pruning.
Case I
Case I had severe childhood trauma, and the consequences still pervade monoaminergic systems, neuroendocrine regulation, and psychological well-being. Even MDMA-assisted psychotherapy did not help.
Case J
J has structural aberrances in the basal ganglia systems due to genetics & “bad luck” during intrauterine development. He is plagued by debilitating thought loops, obsessive tendencies, and impairments in executive functions. Stimulants help for a bit but eventually they “poop out”.
Case K
K is always tired, anhedonic, and prefers to stay by himself. Conventional treatment with several antidepressants was unsuccessful because the underlying problem is an unrecognized autoimmune disorder, which induces sickness behavior due to chronically elevated cytokine levels.
Case L
L is a rationalist and nihilist. After reading the wrong kinds of philosophy, he has successfully trained his neural wetware to use negative and pessimistic thinking patterns. He responds well to bupropion but “blames” his biology for his newfound zest for life and successfully uses reason to subdue any positive emotion. To him, everything is pointless anyway, and the multiverse is an apathetic, cold, and dark place. He stops the bupropion long before new thinking patterns can take hold.
Case M
M’s energy and mood are notoriously difficult to treat. Unbeknownst to her, because of natural variation, she has a significantly lower number of catecholaminergic neurons and adrenergic nerve endings than most people.
Case N
N is constantly drained and zombie-like fatigued. He has tried a lot of different pharmaceuticals and lifestyle interventions, but things do not seem to get better. Unfortunately, nobody has recognized his sleep apnea.
Case O
O suffers from chronic fatigue due to long-COVID. He is treated with stimulants, which help little. Unfortunately, he never learns about immunosuppression, immunoadsorption, or b-cell depletion, which would help him because his fatigue is in part brought about by autoantibodies against endogenous muscarinic and beta-adrenergic receptors.
Summary
Diagnosing as well as treating certain issues can get quite complex quite fast.
Disclaimer
The content available on this website is based on the author’s individual research, opinions, and personal experiences. It is intended solely for informational and entertainment purposes and does not constitute medical advice. The author does not endorse the use of supplements, pharmaceutical drugs, or hormones without the direct oversight of a qualified physician. People should never disregard professional medical advice or delay in seeking it because of something they have read on the internet.