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Depression in a Teenager

Case History

J. a 16 y/o with a strong past history of anxiety & depression caused by anorexia. The mood disorders have lead to a severe case of insomnia; both in sleep onset & maintenance. J. was hospitalized at the age of 14 for a severe case of self-harm (cutting) and remained hospitalized for 4 weeks. Her doctor prescribed an anti-depressant when she was released; however she stopped taking it as it caused severe drowsiness during her school day. Her mother since has encouraged her to partake in mind-body medicine (meditation) which she mentioned has helped her a lot, and she feels more stable than she did after the hospitalization.

After her hospitalization, J. is trying to maintain her weight to 50 kg exactly to avoid that situation from occurring ever again. However she mentioned she still feels extremely depressed, anxious, and still has an extremely negative self-image problem. J. is also having difficulty coping at school due to bullying and peer pressure.

Secondary Signs & symptoms

These include; chronic constipation (can go over a week without any movement), Amenorrhea (menses was at 11 years of age and has only had 8-9 full period in the last 5 years; some have been light spotting or completely skipping her menses-however symptoms are still predominant (dysmennrohea & sugar cravings). She is also suffering from chronic inflammatory acne vulgarism which is the major contributor to her low-self-esteem and anxiety related symptoms. The lesions are occurring all over her face, and back-however the jaw line is the most dominant area. She has also noticed her hair is gradually thinning, and is very concerned about this. She also suffers from frequent colds & flus, and sore throats. Her mother has recently reported that she has halitosis and a thick white coating on the tongue.

  1. is having a lot of difficulty with sleep. She find it incredibly difficult to switch off her mind at the end of the day, and mentioned ‘waking up in a fright’ in the middle of the night and not being able to go to sleep for several hours. On average she is getting 5-6 hours of disturbed sleep per night.  It can take Jenny up to 2 hours after getting in bed to be able to fall asleep. Her energy is at about 3/10 and there are no peaks or drops throughout the day- she feels pretty flat all day. Her memory & concentration are greatly affected by this.
  2. does not eat regularly-her biggest meals are in the evening when her mother is there to supervise her food intake (generally meat & vegetables, stir fries, no carbohydrates), she doesn’t eat anything in the morning for breakfast as it makes her feel sick (nausea & discomfort), and lunch is normally a white bread peanut butter sandwich & some fruit at school. She occasionally binges on chocolate if she gets a craving but suffers with extreme guilt afterwards so tries to avoid this. She currently drinks over 4 litres of tap water daily & takes a chewable vitamin C & women’s multivitamin both from the supermarket.

Objectives

Short-term Goals- to initially to build a trusting & supportive relationship with the patient & provide some symptomatic relief

  • Improve sleep pattern-onset & maintenance therefore increasing energy
  • Elevate mood & Reduce anxiety
  • Enhance the function of the innate & acquired immune system
  • Support gastrointestinal tract & stimulate peristalsis to alleviate constipation-root cause to many secondary symptoms
  • Reduce inflammation & support inflammatory pathways
  • Improve dietary habits & maintain/increase body weight (this should be very subtle)

Long-term Goals-to provide a successful treatment plan that aides the client’s long term health status

  • Improve patient’s self-image
  • Reduce feelings of anxiety/depression
  • Maintain a healthy bowel & bowel motions
  • Provide relief of inflammatory Acne vulgaris
  • Begin the path to a regular menstrual cycle-with a monthly 4-5 day bleed without any major aggravating symptoms
  • Improve thought pattern relating to food consumption & support a positive outlook to food & eating
  • Seek counseling pertaining to history of anorexia, bullying & peer related issues

 

Nutritional Recommendations

5-hydroxy-tryptophan 100mg on rising with juice- 5-hydroxytryptophan has been clinically proven to work as effectively in reducing depressive symptoms, as the popular. This effect is attributed to its supportive effect on serotonin levels, which also aids sleep support in the long-term as well as appetite control. Serotonin levels are strongly related to low self-esteem & frequent constipation. 5-hydroxy-tryptophan must be taken on an empty stomach with a source of glucose.

Broad Spectrum Probiotics (Lactobacillus Rhamnosus HN001, Lactobacillus Acidophilus, Lactobacillus casei, lactobacillus plantrum, Lactobacillus gasseri, Bifidobacterium longum, Bifidobacterium infantis, Lactobaciluss salivarius) 25 billion organism BD – Probiotics are strongly recognized in the literature to decrease intestinal transit time (ITT) and increase peristalsis. Probiotics are also vital in supporting the immune system and managing the symptoms of medically diagnosed IBS by improving gut flora. Dysbiosis caused by long-term malnourishment is the target for probiotics.

Glutamine powder 1500mg BD- Acts as  demulcent in the gastrointesntinal tract, fuel for intestinal enterocytes, immune enhancer, improvements in gut Motility, Nero-inhibitory neurotransmission, supports gut mucosal growth, promotes and regulates bowel healing.

Vitamin C 1g BD- Anti-inflammatory agent, antioxidant, connective tissue support, skin anti-inflammatory, immune system modulator, adrenal support.

Vitamin A 2500IU BD- Mucous membrane trophorestorative, lipid antioxidant, anti-inflammatory, skin anti-inflammatory, maintains gap junctions between cells, maintainence of the myelin sheath, Vitamin A is the most specific nutrient for acne of any form.

Zinc Gluconate (equiv zinc-4mg) BD-Stimulating the appetite. It has also been shown in clinical trials to be as effective as tricyclic antibiotics in the treatment of acne.

Bioflavanoids 1000-1500mg BDanti-inflammatory, antioxidant effects. Taken before meals to act as a digestive enzyme bromelain

Adenosine 100mg sublingually on retiring-Adenosine is the sleep molecule of the brain that is required for sleep initiation.  It is known to be an inhibitory neurotransmitter and acts on neuromodulationAdenosine accumulates in the hypothalamus during the awake phase, and reaches a threshold depending on activity, inhibiting neural activity in the wake-promoting brain regions that induce rest & sleep. Adenosine levels in retina are up-regulated when in the dark in comparison to when in the light. It also increases the circadian clock mechanism thereby increasing extracellular adenosine in the evenings.

Dietary Recommendations-

  1. has difficulty eating food in the morning which is indicative of several malfunctioning biochemical processes. To help her get in some extra calories in the morning a natural pea protein shake/brown rice protein shake has been recommended. Also to avoid any gastrointestinal upsets that she normally experiences on consumption of dairy products these have been temporarily removed from the diet. Also the inclusion of high protein frequent snacking has been implemented in the form of tuna/nuts & seed/ lentils & nut butters. Smoothies & high caloric liquids have been implemented. Coconut oil has been included in the diet also as a nutritive & calorie provider. Cholesterol intake is vital for her to produce an appropriate amount of hormones to help alleviate the amenorrhea. Her water intake has been reduced to 2L of filtered a day to avoid electrolyte imbalances.

Conclusion

Since her initial consultation, 4 weeks ago, Jenny has noticed a significant improvement in her sleep, skin and mood.

  • Sleep hours increased to minimum 7 hours (initiation improved, still some waking throughout the night)
  • Motivation, memory and concentration improved significantly
  • She is having great personal success with recommended counselor after 3 sessions
  • Energy increased from 3/10 to 7/10
  • Her skin is feeling less ‘rough, red & raw’
  • Bowel motions more frequent, however still not daily
  • Yet to have a menstrual bleed – however understands that this could take some time.

More treatments are needed and J. is happy to take a break for now.

Christine Gozlan

B.H.Sc. Naturopathy

Dip. Herbal Medicine

Dip. Nutrition