When I first saw Mary in my office—an 18-year-old woman diagnosed with ADHD and anxiety—she was extremely anxious.
Perspiration flowed down her face, she was constantly shaking her legs, there was a tremor in her hands, and her voice cracked as she told me her story.
Mary was in her last year of high school, and an avid softball player. Six months earlier, she had been in a car accident, which required surgery that had stopped her from participating in sports—an accident, she added, that had made her nervousness a lot worse.
Now, she had many of the classic symptoms of post-traumatic stress disorder (PTSD): avoidance; a heightened startle response, intrusive thoughts that interfered with her focus at school; nightmares; and constant sense of isolation and disconnection.
Mary had seen a psychiatrist, who had prescribed Dexmethylphenidate XR, 20 mg per day, and Escitalopram, 15 mg per day.
She said the medications for ADHD had been very helpful, but she disliked the feeling of being so “zoned in”—so focused and attentive—that she felt isolated.
After listening to Mary’s story, I talked with her about the possibility that her elevated anxiety could be trigged by the Dexmethylphenidate XR—and we agreed to lower the dose. We kept her Escitalopram at 15 mg. I also suggested she take a magnesium supplement at bedtime, and she agreed to start taking magnesium glycinate, 420 mg, before she went to bed.
Bloodwork, revealed the following:
- Vitamin B12, 237 pg/mL (low)
- Folate, 7.2 ng/mL (low)
- Vitamin D, 5000 IUs
I put together a treatment plan that included a referral to accelerated
Resolution Therapy—which combines CBT, EMDR, and exposure therapy—to help her resolve her recent trauma. I also treated her with subcutaneous methylcobalamin (and active and bioavailable form of B12), 1 mg, twice per week, for 8 weeks. I prescribed 1 mg of L-Methyl-Folate per day. And we optimized her vitamin D supplementation, at a lower dose of 1000 IU per day.
Mary came in for a follow up visit two months after we implemented her treatment plan. Follow up labs showed normal levels of B12, folate, and vitamin D. Mary told me that all of her PTSD symptoms had gone away—the disturbing thoughts, the nightmares, all of it. She said she’d been much less isolated—much more involved with her family and boyfriend. And her academic performance had improved.
Her father had accompanied Mary to her follow up appointment. Before they left, he said to me, “I don’t know what you did—but I have my child back.”
