Initial Presentation

Patient Demographics

• Name: Isabella (Name changed for privacy)
• Age: 17
• Ethnicity: Latina
• Location: New York City
• School: Enrolled in a magnet program with a demanding academic workload

Chief Complaints

• Mood instability: Irritability, anger, and emotional variability, especially with parents
• Sleep disruption: Poor sleep quality, averaging 4-5 hours per night
• Fatigue: Low energy overall, highest in the morning, dips in the afternoon, and surges late at night
• Headaches: 2-4 times per week
• Menstrual health: Polycystic ovarian syndrome (PCOS); currently taking birth control pills (BCP)

Relevant Medical & Family History

• No history of self-harm or suicidal ideation
• Family history of depression and metabolic disorders
• No previous psychiatric hospitalizations

Clinical Assessment:

Diagnosis

1. Polycystic Ovarian Syndrome (PCOS)
2. Generalized Anxiety Disorder (GAD) and Depression
3. Cortisol Dysregulation and Adrenal Fatigue

Objective Findings

• Laboratory Testing:
  • Elevated androgens (suggestive of PCOS-related hormonal imbalance)
  • Mild insulin resistance (elevated fasting insulin)
  • Elevated evening cortisol
  • Low vitamin D, magnesium, and B12
  • Mildly elevated C-reactive protein (CRP), indicating inflammation
• Behavioral and Psychological Observations:
  • Appears withdrawn and fatigued during consultation
  • Expresses feelings of being overwhelmed by school workload

Intervention and Treatment Plan for PCOS, Anxiety, and Depression:

1. Lifestyle and Sleep Hygiene

• Establish consistent bedtime routine
• Reduce light exposure 1 hour before bed
• Magnesium Glycinate (200 mg) before bed to improve relaxation and sleep quality
• Daily mindfulness/meditation (5 minutes) to reduce stress and anxiety

2. Nutritional Support & Supplementation

• Dietary Adjustments:
  • Increase protein and healthy fats at each meal
  • Reduce refined sugar and processed carbohydrates
  • Increase anti-inflammatory foods (e.g., turmeric, leafy greens, omega-3s)
• Supplements:
  • Vitamin D3 (2,000 IU daily) – Supports immune function and mood (Holick, 2011)
  • Magnesium Glycinate (200 mg twice daily) – Improves sleep and relaxation (Boyle et al., 2017)
  • Inositol (4 g daily) – Supports insulin sensitivity and hormone regulation in PCOS (Unfer et al., 2017)
  • B Complex (with methylfolate and B12) – Supports neurotransmitter function and energy (Young, 2007)

3. Botanical & Nutraceutical Interventions:

• SAMe (200-800 mg daily): Methyl donor that reduces depressive symptoms (Papakostas, 2010)
• Adrenal Glandular (morning and early afternoon): Supports adrenal function (Wilson, 2014)
• Magnolia (evening): Reduces stress perception and cortisol exposure (Talbott et al., 2013)
• Ashwagandha (evening): Adaptogen that reduces stress and anxiety (Chandrasekhar et al., 2012)
• Melatonin 1.2 mg (slow release, before bed): Supports circadian rhythm and sleep regulation (Ferracioli-Oda et al., 2013)
• L-Tyrosine (morning): Enhances alertness, mental performance, and memory (Neri et al., 1995)
• Curcumin (morning and evening): Reduces inflammation and supports mood (Lopresti et al., 2014)
• 5-HTP (evening): Increases serotonin levels and supports mood stability (Birdsall, 1998)

Progress Evaluation:

October Follow-up (4 Weeks Post-Treatment Initiation)

• Mood: Less irritable and sad, though some fluctuations remain
• Energy: Improving, especially in the morning and early afternoon
• Sleep: Increased to 5-6 hours per night
• Headaches: Reduced to 1 per week

January Follow-up (3 Months Post-Treatment Initiation)

• Mood: Parents report that they “feel like their daughter is back”; Isabella reports no sadness
• Energy: Increased and stable throughout the day
• Sleep: Improved to 7-8 hours per night
• Headaches: Reduced to 1-2 per month
• Emotional Stability: More joyful, engaged, and motivated

Follow-up Lab Testing (January)

• CRP (Inflammation Marker): Lowered, indicating reduced systemic inflammation
• Fasting Insulin Levels: Improved, suggesting better metabolic control
• Evening Cortisol Levels: More balanced, reflecting better stress management

Conclusion and Long-Term Treatment Plan

Isabella experienced significant improvements in mood, sleep, and overall well-being with a comprehensive integrative medicine approach. Her case highlights the effectiveness of addressing hormonal balance, neurotransmitter function, and lifestyle modifications for adolescent mental health.

Next Steps:

1. Continue supporting sleep and stress resilience
2. Maintain hormonal balance with ongoing monitoring
3. Encourage emotional and academic balance