Holistic Approach to OCD

& the Limits of Testing For Genetic Variants

This newsletter is in response to several questions I’ve received from those trying to understand how their genetic variants relate to their symptoms and how they can address those variants.  I’m also responding to a reader wanting to learn more about what I do as a holistic psychiatrist.

Below is a case study I’ve created based on patients I’ve seen in my practice, spoken to for non-patient phone consultations, and frequent reader questions. This is intended for education and not treatment recommendations.

Case Study

Nora is a 35-year-old woman who has lifelong symptoms of OCD that have taken different forms over time and have included contamination fears, checking, and intrusive thoughts.  When she was 12, her OCD symptoms worsened. In the last two years, they have further increased in intensity. 

She describes herself as perfectionistic, competitive, and driven in her work.  She has difficulty relaxing and being present in her relationships.  She denies having a depressed mood but says that she becomes irritable when under stress.  She also ruminates about her health.   

Nora has a range of physical symptoms that come and go, including muscle twitches, nausea, racing heart, muscle tightness, and headaches.  She does notice some worsening of her OCD and anxiety symptoms in the middle of her cycle and right before her period. She also gets bloating, headaches, and breast tenderness.

Psychiatric History

She has tried several medications without benefit, including SSRI antidepressants. She has been in therapy on and off over the years.

Medical History

Nora has seasonal allergies. In the past two years has had sinus infections averaging every 3-4 months and requiring antibiotics.

Environmental History

She moved into her current home two years ago. She doesn’t know of any water damage or changes in EMF exposure. 

Family History
Nora’s father also had OCD and had a pacemaker for cardiac arrhythmias

Lab Testing

MTHFR +/- MTHFR is the main variant contributing to undermethylation. Other genes, however, can offset this. Methylation is involved in the breakdown of histamine and is important in neurotransmitter functioning and detoxification.

Slow COMT +/+ COMT degrades catecholamines (dopamine, norepinephrine, epinephrine) and estrogen.  If it is “slow,” these can build up.

Slow MAOA +/+ MAOA degrades catecholamines and serotonin. If it is “slow,” these can build up.

Reactions to Supplements

After reading about methylation, Norah tried various supplements:

B6, methyl B12, and SAMe increased her anxiety.

Folate made her feel depressed and anxious.