Patient Overview
Marie, a 43-year-old Haitian immigrant, presented with long-standing ADHD symptoms, including poor focus, agitation, irritability, and frequent feelings of being overwhelmed and “spacey.” Her early life was marked by significant trauma, including separation from her brother and time in foster care. As an adult, she continues to struggle with issues of abandonment, trust, and social anxiety. She also carries a diagnosis of dyslexia, which contributed to ongoing academic and self-esteem challenges.
Psychiatric History
Marie’s psychiatric history includes PTSD, postpartum depression, and anxiety. At age 18, she attempted suicide with Tylenol, describing it as a cry for help. She has tried multiple antidepressants and stimulants over the years, including Celexa, Wellbutrin, sertraline, Focalin, and Rhodiola.
Family Psychiatric History
Her mother was an alcoholic, and her brother attempted suicide. Both of her children, ages 10 and 7, have ADHD, highlighting the genetic component of her presentation.
Laboratory Findings
Comprehensive testing provided critical insight into her underlying imbalances:
- Vitamin D: 22 (low)
- B12: 496
- Homocysteine: 7.4
- Alkaline Phosphatase: 45
- ION Panel: low potassium, low magnesium, low omega-6; tryptophan and histidine low; glutamic acid elevated; 3 elevated bacterial markers
- OAT: unremarkable
- Genetics (Tempus): Heterozygous for MTHFR C677T
Treatment for ADHD & PTSD
Marie was treated with an integrative plan combining psychiatric medication and nutritional interventions. Her regimen included the following medications and supplements:
- Lisdexamfetamine 30 mg
- Lithium orotate 20 mg (notably effective in reducing irritability and anger)
- Sertraline 50 mg
- 5-HTP, B-complex, magnesium glycinate, zinc, omega fatty acids
- CurcumaSorb Mind, Enlyte D, Vitamin C
- Vitamin D3 10,000 IU (initiated for repletion)
Clinical Course & Outcomes
Over time, Marie experienced substantial improvement. With lithium orotate, her irritability decreased significantly, allowing her to regulate emotions more effectively. Stimulant therapy became tolerable once her underlying imbalances were corrected. Importantly, Marie demonstrated excellent follow-through with lab testing and treatment recommendations, a key factor in her progress.
Marie reports greater focus, reduced anger, and increased stability. These changes have not only supported her own well-being but also helped her become a more patient and effective parent to her two young children with ADHD. Today, she is stable, engaged, and pursuing her dream of opening a dance studio.
Clinical Insights
- Comprehensive testing matters: Functional lab work revealed deficiencies and imbalances that guided targeted interventions.
- Lithium orotate can be a powerful adjunct: Even at low doses, lithium provided emotional stabilization and reduced anger.
- Follow-through predicts outcomes: Marie’s willingness to complete testing and adhere to treatment recommendations was critical to her success.
- Family ripple effect: Supporting a parent with ADHD and trauma can directly improve family dynamics, especially when children also face similar challenges.
Pearl for Practice
In complex ADHD cases with trauma history, combining stimulant therapy with targeted nutritional support and low-dose lithium can stabilize mood, enhance focus, and support long-term resilience.
