One day, I received a call from a severely distressed trauma nurse named Emmy, referred to me by a State Wellness Program — a program providing free and confidential mental health support for medical and nursing professionals. After listening to her story for 45 minutes, I agreed to see her as a patient. Over her 20-year-long career as a pediatric trauma nurse, she witnessed devastating traumas, including a 12-fold increase in pediatric suicides during her tenure.
She has never reached out to a mental health provider. Her primary care provider has been prescribing her eszopiclone for over 10 years. Eszopiclone is a sedative-hypnotic drug used to treat insomnia.
While she reported that she was always able to “hold it together” in her challenging job, she recently found herself triggered and haunted by her own memories of trauma. She relayed the flooding of memories from early childhood, including sexual abuse, neglect, and extreme poverty. Over the years, she managed her chronic insomnia, the stress and grief of her life with Eszopiclone, alcohol, and cannabis.
The use of substances to escape emotional distress might temporarily numb painful emotions, but substance misuse tends to worsen underlying mental health issues, increase stress, and impair healthy coping strategies. As she felt she had lost her ability to function and manage her emotions, she made a plan to take her life. However, the excessive guilt she felt about her reckless behaviors up to this point, and leaving her husband and her twin sons behind, ultimately stopped her.
With few options left, Emmy reached out for a referral in our State Wellness program in order to maintain confidentiality and was referred to me. After our first session, Emmy agreed to undergo a functional psychiatry workup.
Functional Lab Testing included:
- Testing for Vitamin D, B12, Copper, Zinc, Homocysteine, CRP, Cholesterol, CMP, CBC, TSH, T4, Kryptopyrrole Test, Microbial Organic Acid Test (MOAT), and genetic testing, including MTHFR
The reasoning behind these tests were manifold:
- Low levels of key nutrients and metabolic markers such as vitamin D, vitamin B12, zinc, cholesterol, and certain hormones (thyroid, estradiol) are well-documented contributors to insomnia, depression, anxiety, mood instability, irritability, and cognitive symptoms.
- Elevated Copper can also cause psychiatric symptoms like anxiety, depression, hyperactivity, and poor concentration.
- Genetics (MTHFR) mutations are linked to depression, anxiety, bipolar disorder, ADHD, and schizophrenia.
- Pyrrole testing (Pyrrole disorder, also known as pyroluria, is an abnormality where the body overproduces hydroxyhemoppyrrolin-2-one (HPL). This is believed to bind to and deplete the body’s zinc and vitamin B6 which can result in anxiety, depression, mood swings, and low stress tolerance.
- MOAT- Testing for gut dysbiosis, which is an imbalance of gut bacteria, is often linked to anxiety and depression. It can contribute to these symptoms by causing neuroinflammation, altering neurotransmitter production (like serotonin), and triggering a heightened stress response.
- Complex trauma and chronic stress elevate cortisol levels, which rapidly deplete nutrients and can impair the body’s ability to absorb and retain minerals.
Current Psychiatric Medications:
Eszopiclone 3 mg for insomnia for 10 years.
Family Psychiatric history:
Maternal uncle died by suicide, alcoholism on both sides, and rampant sexual abuse in her family of origin.
Laboratory Findings:
Genetics: Heterozygous for MTHFR C677T
Kryptopyrrole negative
Microbial Organic Test: Negative for gut dysbiosis
Vitamin D 32.9 (low), Copper 102, zinc 83 (low)
Treatment
I recommended 5 mg nutritional lithium orotate to target suicidality, anger, and impulsivity. There is significant research supporting an association between low trace lithium levels and higher suicide risk. Additionally, some individuals have a greater need for lithium related to genetics, family history of suicide, and substance use disorder, which suggests a strong need for lithium supplementation.
Additionally, we met in person weekly for integrative evaluation and supportive therapy. I also recommended the following:
- A three-month medical leave
- Weekly individual therapy with a first responder, including Eye Movement Desensitization and Reprocessing — a structured form of psychotherapy used primarily to treat trauma and post-traumatic stress disorder
- B complex with L-methylfolate to target MTHFR mutation
- Lithium orotate 5 mg to target suicidality, impulsivity, and reactivity
- Vitamin D 5000 to address a suboptimal level below 50
- Zinc 30 mg to target a suboptimal level below 100
- Magnesium glycinate 240 mg at HS for insomnia and anxiety
- Prazosin 1 mg for nightmares.
- Eszopiclone taper
Clinical Course and Outcomes
Emmy has since returned to work. She takes Fridays off for self-care. She is not taking on extra shifts. She reports less irritability and can parent more calmly. She has also maintained sobriety from cannabis and alcohol. She is sleeping well, without taking sleeping aids.
Clinical Insights
- Integrative testing can reveal deficiencies that contribute to psychiatric symptoms.
- Nutritional Lithium can be used to target suicidality, especially with substance abuse and a family history of suicide.
- Magnesium Glycinate can be beneficial for insomnia and anxiety. Supplementation can provide support to pursue trauma healing, taper off medications, sobriety support, and return to work.
Pearls for Practice: The Power of Integrative Psychiatry
Lithium, in nutritional doses, can be integral in treating patients with suicidal ideation and addiction. In complex trauma cases, a team approach is necessary. Connection and support were imperative. Emmy had a lot of shame around her behaviors and greatly appreciated a non-judgmental environment. She was relieved to realize that her situation was not her fault.
