Case Study 5

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.