Patient 5: INSOMNIA FOR 50 YEARS, TREATMENT RESISTANT BIPOLAR DISORDER, CHRONIC FATIGUE AND PAIN.
Female,
Age 74.
This is a real patient history. Their identification details have been removed to maintain the patient’s privacy.
Initial Presentation - 14/11/18
- History of non-resolving anxiety and depression over 30 years. Insomnia for a long period of time. Diagnosis of bipolar disorder but not responding to treatment.
- Her husband had committed suicide 30 years ago. She has five troublesome children causing chaos in her life all the time.
- Feels tired all the time.
- Overwhelmed, never sleeps any more than 4 hours. Sleep never gave her any refreshment.
- Takes Ativan to keep her mood up.
- On Endep 25mg, Brintellere 10mg, Nexium 40mg, Mobic 15mg, Panadeine forte and Tramadol (had been treated by a psychiatrist , but not feeling better).
- She had been diagnosed to have bipolar disorder.
- Has got osteoporosis and on Prolia, Vit D and Calcium.
- Chronic neck, shoulder and lumbar back pain.
- Important History
- 3 Caesarean Sections
- Fundoplication 18 years ago
- Shoulder repair 16 years ago
- Gallbladder removal 14 years ago
- Both knees replaced 3 years ago
- Multiple nerve ablations – cervical and lumbar
- Multiple cortisone injections to nerve roots
- Fell off a horse 20 years ago – Back Injury
- Ruptured multiple discs compressing spinal cord – recovered without being quadriplegic
- On panadeine forte and tramadol for a long time for pain relief
- She has been having a lot of stress due to her four children who are unhappy with how much ever she gave to them.
- Was on Pristiq 250mg – not relieved
- Lexapro – did not tolerate
- Cymbalta 120mg – Bit better with this
- In 2013, Cymbalta was weaned off, Cipramil 20mg and Seroquel 50mg nocte started, but was not very effective.
- She has no allergies
- Non – smoker
- Drinks 2 – 3 times a week
- No family history of significant conditions (no mental disorders)
- On Examination
- Very drained out, tired, weary looking, obese, tenderness in neck, shoulders and back
- Normal BP
- No other significant physical abnormality except being obese, tenderness in right shoulder, neck and lumbar areas.
- Pathology Testing
- Serotonin – 1748 (Normal)
- Blood Counts – Normal
- Blood Heavy Metals – Normal – Copper 19.4 (13.0 – 25.0)
- Normal Ceruloplasmin Level
- Serum Cortisol;
- 284 nmol/L (8am)
- 196 nmol/L (12 noon)
- 229 nmol/L (4pm)
- Vit D – 88
- Normal Iron Levels
- Vit B12 – Normal, but not optimal
- Folate – 17
- Liver Function Test – Normal
- Fasting BGL – Normal
- Lipids – Normal
- Homocysteine – 10.5
- Normal Thyroid
- Biogenic Amines – Urine Noradrenaline 636 (normal up to 600)
- Adrenaline – < 27 (<120)
- U – Dopamine – 2.44 (<3.50)
- Assessment Questionnaire
- No prominent depression and anxiety symptoms
- Beck’s Depression Score – 9
- Beck’s Anxiety Score – 2
- Hormone Questionnaire
- No signs of oestrogen/progesterone problems in the past
- Mild Fatigue Score
- Low Scores in Brain Health Questionnaire
- Yeast symptom Score – 96
- Dysbiosis Score – 21
- Initial Treatment Commenced 05/12/18
Review 10/12/18
- Feels better
- Anxiety is very much less
- More energetic
- Has started going to gym
Functional Medical Reports 29/01/19
- Neurotransmitters:
- Serotonin – High Normal
- GABA – Normal
- Glutamate – High
- Dopamine – High
- Noradrenaline – High (Worse than all)
- Adrenaline – Normal
- Noradrenaline/ Adrenaline Ratio – Normal
- Salivary Cortisol – 8am, 4pm, 8pm – Normal, 12 noon – High
- DHEA – Low
- Candida Antibodies – High
- Plasma Amino Acids
Review – 17/04/19
- Sleeps well
- More energy
- Depression and anxiety are very much less
Review – 01/05/19
- Very relaxed, feels well overall
- Sleeps very well
- Very energetic
- No anxiety or depressive symptoms anymore
- Patient was asked to continue the same treatment and still going on well.
- She also got her right shoulder replaced. Not in much pain.
Author
Dr. Priyanta Thotagamuwa (MBBS, FRACGP)
Dr. Priyanta Thotagamuwa (MBBS, FRACGP) is operating Wandal Medical Centre in Rockhampton with the aim and interest of treating patients in a holistic manner. As a GP he offers medical assistance to patients of all ages, seeking advice, treatment or minor procedures.
Dr. Priyanta Thotagamuwa (MBBS, FRACGP)
Dr. Priyanta Thotagamuwa (MBBS, FRACGP) is operating Wandal Medical Centre in Rockhampton with the aim and interest of treating patients in a holistic manner. As a GP he offers medical assistance to patients of all ages, seeking advice, treatment or minor procedures.