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    The Story of Alan

    When Alan first presented for evaluation and treatment in our Root Cause Psychiatry Program, he was in rough shape. He was 26 years old and had recently dropped out of law school because he was unable to function and “on the verge of collapse. Alan had been in psychiatric treatment continuously since he was twelve years old, and he was feeling quite hopeless that any psychiatrist could help him, as he had been on virtually every class of psychiatric medication, along with years of psychotherapy, which had “held him together” but had never brought about a full recovery and had failed to restore the joy in life that he had felt as a child. He was quite skeptical that we could help him, which was quite understandable as psychiatry had largely failed him up to now. Here is a summary of his genetic and laboratory test findings and response to treatment over a twelve-month period.

    Psychiatric Management and Medication Adjustments: Alan’s healthcare journey commenced with a challenging array of psychological symptoms: profound fatigue coupled with academic-related anxiety, persistent depression, and pervasive sleep disturbances. To address these, his psychiatric medication regimen was thoughtfully reassessed. The initial consideration to replace Escitalopram with Trintellix was guided by our finding that he had an SLC6A4 S/S genetic variant which predicts poor response and a high likelihood of side effects on SSRIs (selective serotonin reuptake inhibitors). A history of Seasonal Affective Disorder, combined with his longstanding joylessness and lack of pleasure in life supported the addition of Bright Light Therapy, which was recommended to recalibrate his disrupted circadian rhythm and mitigate depressive symptoms.

    Further Genetic Discoveries and Targeted Treatment Strategies: A series of genetic tests unveiled several polymorphisms, offering a window into the patient’s unique biochemical milieu. A BDNF variant (the brain’s “fertilizer gene”) suggested enhanced stress sensitivity, warranting the initiation of high-dose Omega-3 supplements to bolster BDNF gene expression and reduce brain inflammation to help his neurological function. The detection of a CACNA1C genetic variation implicated in neuronal instability informed a cautious up titration of Magnesium Threonate, aiming to stabilize neurotransmitter activity. The COMT VAL/VAL genotype revealed a rapid clearance of dopamine, necessitating precise medication adjustments which involved slowly increasing doses of Wellbutrin, added to the Trintellix, to improve his cognition, motivation, and drive.

    Gastrointestinal Health and Nutritional Focus: His treatment journey further navigated the complexities of digestive health. Low pancreatic enzyme activity prompted an intervention with supplemental enzymes and Ox Bile to enhance fat digestion and absorption. The diagnosis of methane positive SIBO (Small Intestine Bacterial Overgrowth) brought about a specific treatment protocol and dietary changes, highlighting the intricate link between his gastrointestinal function and broader mental health concerns. The meticulous crafting of his diet, characterized by a rich variety of vegetables and adequate hydration, was complemented by a strategic plan to avoid high FODMAP foods, which had been identified as potential triggers of his digestive discomfort.

    Addressing Sleep Disorders and Enhancing Rest: Sleep quality was a critical component of Alan's comprehensive care plan. A tailored approach to address his sleep cycle disruption involved multiple interventions, including the therapeutic use of medical marijuana tinctures and THC gummies. Despite these measures, a detailed sleep study uncovered a severe sleep apnea diagnosis, leading to the introduction of CPAP (Continuous Positive Airway Pressure) therapy to alleviate nocturnal breathing interruptions. This intervention was particularly critical given the structural abnormalities noted by an ENT specialist, such as enlarged tonsils and extra tissue on the soft palate, which had been contributing to his lifelong snoring and sleep disturbances.

    Incorporating Physical Activity into Recovery: Physical movement was recognized as a vital pillar of her recovery. Regular dog walking sessions provided not only a means of physical exertion but also a routine that brought structure to his days and exposure to natural light. The pursuit of more structured exercise followed, with a gym membership and the introduction of Pilates alongside friends, reinforcing the importance of social support in his commitment to an active lifestyle.

    Metabolic Health and Hormonal Balance: Lab tests illuminated various metabolic imbalances. Elevated uric acid and homocysteine levels alongside a significant deficiency in vitamin D were methodically addressed with dietary supplementation. These interventions aimed to attenuate systemic inflammation and enhance his metabolic efficiency, thereby potentially alleviating some of his mood and energy-related symptoms.

    Integrative Approaches for Gut Health: Alan’s pursuit of gut health led to the incorporation of a triple probiotic regimen and the addition of probiotic-rich foods, strategically aligned with his antimicrobial treatment for Salmonella. The eradication of this pathogen, coupled with a focus on rebalancing his gut microbiota, was a crucial aspect of his journey, considering the gut-brain axis's influence on mental health.

    Holistic Care Emphasizing Mental and Physical Well-being: In addressing his mental health, Alan was supported not only by medication but also through working with a therapist to navigate the complexities of emotional eating and weight management. This holistic care approach underscored the inseparable connection between mental well-being and physical health.

    Educational Goals and Personal Development: Throughout his complex treatment regimen, Alan maintained a steadfast focus on personal development and educational goals. As he began to feel better and function more effectively, Alan returned to law school and began taking control of his dietary choices by cooking his own meals, which became empowerment and recovery.

    In this intricate and responsive healthcare journey, Alan’s story is marked by resilience and adaptability, reflective of the profound impact of personalized, integrative healthcare that embraces both the science of medicine and the art of healing.

    Alan recently began working at a law firm and is dating a woman he really likes. After our twelve-month journey together, we could not have been happier for him!

    Learn more about Root Cause Psychiatry today!

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