Case Study 3

Patient 3: NON-RESOLVING ANXIETY, CHRONIC FATIGUE.

Female, 
Age 27. 

This is a real patient history. Their identification details have been removed to maintain the patient’s privacy.

Initial Presentation

  • Presented with severe stress caused by workplace bullying (She is the manager of a local restaurant). She has been suffering from severe anxiety since the age of 13 and has been biting her lips and finger nail folds (all of them are damaged). She had been prescribed endep in the past which she stopped due to excessive sleepiness.
  • Patient was impolite and agitated during first consultation in 2015. According to conventional guidelines, Effexor was started and brought up to 150mg. Patient felt better with the treatment initially. 5 months later she presented with extreme stress and worsened anxiety, not sleeping well, lack of appetite, withdrawn and suicidal after she had been demoted from her manageress position.
  • Patient was referred to acute care mental health team for her safety.
  • Diazepam 2mg bd added (by acute care  team)
  • Patient started to feel little better to a certain extent but never been completely OK. She also said that she had been spotting for the last 2-3 years and on combined OCP. She resigned from her job at the end of 2015.
  • In January 2019, she sought further care due to non-resolving anxiety, depression and ongoing extreme tiredness. Patient was assessed using alternative care questionnaires.
  • In her life history,
    • Non-resolving anxiety for the past 15 years
    • Poor sleep since the childhood
    • Ongoing constipation
    • Nail and lip biting all the time
    • Appendicitis and surgical treatment at the age of 15
    • Has been on Effexor 150mg for 4 years without good success
  • Family History
    • Mum – Depression
    • Maternal Grandmother – Depression
    • Father – Anger Issues
    • No-known food and drug allergies
  • Examination
    • Avoids eye contact, very rude reactions, nail folds of all the fingers are damaged due to chronic biting. Depressed mood and frequent blinking of her eyelids.

Results of the Assessment Papers

  • Multiple symptom score – 125
  • Fatigue Questionnaire Score – 125
  • Yeast symptom Score – 330
  • Dysbiosis Score – 79
  • Beck’s Depression Score – 42
  • Beck’s Anxiety Score – 34
  • DASS – Depression – 20, Anxiety – 5, Stress – 17
  • Brain Health Questionnaire showed high scores in all brain areas
  • Neural tissue  inflammation

Neurotransmitter Testing Results

  • Serotonin; GABA – Very Low Normal
  • Glutamate and Dopamine – Low Normal
  • Noradrenaline – Very Low Normal
  • Adrenaline – Lower than normal limit
  • Methylation Genes
  • Patient was homozygous only for MTRR SNP
  • Even though cortisol, melatonin, female hormone profile and oestrogen metabolites were needed to be checked, due to financial constraints, patient did not agree to do further testing.

Review 1

  • Two months after starting treatment, patient became more settled down, stopped biting her finger nails, started making eye contact, had engaging conversations, and started to get more energy.

Review 2

  • Patient started feeling much better afterwards.
  • She is no longer anxious, keeps good eye contact, behaviour is very polite and friendly
  • She is still on her maintenance treatment and hasn’t gone downhill at all