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.