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Case Study: Mary, a 43-Year-Old Female with PTSD

While all case studies are based on actual patients, significant aspects of the case have been changed to conceal the patient’s original identity.

Initial Presentation

Mary came to me due to a resurgence of post-traumatic stress disorder (PTSD) symptoms. She had been retriggered by a recent patient. Mary worked as a trauma counselor and a patient’s vivid description of sexual abuse as a child shared striking similarities with her own experience of abuse. Normally, Mary could compartmentalize her past experiences and not let it interfere with her work. However, her flashbacks and nightmares resurfaced with a vengeance when the younger patient, who reminded her of herself, described what she had experienced.

Due to her excessive symptoms, Mary had taken a leave of absence from work. However, even without the stress of work, she was having daily panic attacks, flashbacks and nightmares.

Mary had been heavily relying on cannabis before bed in an attempt to help her sleep and block out the memories. With her family, she had become increasingly irritable, snapping at any perceived slight. Her husband expressed concern, but she described feeling flat and unable to engage or connect. She also had a family history of substance abuse with her grandfather and aunt having died from alcoholism.

Initial Relevant Labs

  • 25-hydroxy vitamin D low at 23 ng/mL
  • RBC magnesium low at 3.6 mg/dL

Working Diagnosis

  • PTSD

Initial Treatment

  • Vitamin D, 5000 iu
  • Magnesium glycinate, 240 mg twice per day
  • Lithium orotate, 5 mg
  • Eye movement desensitization and reprocessing (EMDR)


Low vitamin D and vitamin-D-binding-protein polymorphisms have both been associated with PTSD (Terock 2020). Low levels of vitamin D have also been shown to correlate with lower resilience, a risk factor for poor mental health outcomes due to stressful situations (Terock 2020). Preliminary research even suggests that stress resilience can be improved with vitamin D supplementation (Hansen 2020).

For magnesium, low levels in animal research have been shown to be associated with increased anxiety and dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis (Sartori 2012). Magnesium deficiency can exacerbate stress as the mineral plays a key inhibitory role in the normal stress response (Pickering 2020). Other research suggests benefits for depression with magnesium supplementation (Afsharfar 2021).

Lithium is well recognized for its effects on bipolar disorder. Yet additional research suggests benefits for reducing aggression and irritability. A study in Alzheimer’s patients with low-dose lithium found reductions in lability and irritability (Devanand 2022). Trace levels of lithium in drinking water also appear to help reduce suicide, aggression and violent behaviors (Giotakos 2018). Due to Mary’s irritability, low-dose lithium was implemented to help control her symptoms.

EMDR is a treatment for PTSD and trauma. In comparison trials, it shows equivalency to cognitive behavioral therapy and superiority to medication (Snyder 2022).

Follow-up Presentation

After four months, Mary’s symptoms were significantly improved. She had been able to restart work and had re-engaged with her family. While she still did have occasional flashbacks, they didn’t trigger severe panic or anxiety. Her irritability had improved and she had stopped using cannabis before bed to sleep.

Follow-up Testing

  • 25-hydroxy vitamin D normal at 38 ng/mL
  • RBC magnesium 5.0 mg/dL

Follow-up Treatment

The supplements were continued without changes. Mary was also encouraged to maintain EMDR treatments to help encourage further progress in PTSD symptom reduction.

Case Summary

PTSD is a complicated condition. And frequently, biochemical imbalances exacerbate symptoms. Mary’s case highlights two common deficiencies that frequently plague patients: vitamin D and magnesium. For patients struggling with irritability–and for those with a family history of substance abuse disorders–low-dose (nutritional) lithium can also be helpful. As Mary’s biochemistry came back into balance, she was able to more effectively engage in EMDR which further reduced her trauma-induced symptoms.

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Afsharfar M, Shahraki M, Shakiba M, Asbaghi O, Dashipour A. The effects of magnesium supplementation on serum level of brain derived neurotrophic factor (BDNF) and depression status in patients with depression. Clin Nutr ESPEN. 2021;42:381-386. doi:10.1016/j.clnesp.2020.12.022

Devanand DP, Crocco E, Forester BP, et al. Low Dose Lithium Treatment of Behavioral Complications in Alzheimer’s Disease: Lit-AD Randomized Clinical Trial. Am J Geriatr Psychiatry. 2022;30(1):32-42. doi:10.1016/j.jagp.2021.04.014

Giotakos O. Is impulsivity in part a lithium deficiency state?. Psychiatriki. 2018;29(3):264-270. doi:10.22365/jpsych.2018.293.264

Hansen AL, Ambroziak G, Thornton D, et al. Vitamin D Supplementation during Winter: Effects on Stress Resilience in a Randomized Control Trial. Nutrients. 2020;12(11):3258. Published 2020 Oct 24. doi:10.3390/nu12113258

Pickering G, Mazur A, Trousselard M, et al. Magnesium Status and Stress: The Vicious Circle Concept Revisited. Nutrients. 2020;12(12):3672. Published 2020 Nov 28. doi:10.3390/nu12123672

Sartori SB, Whittle N, Hetzenauer A, Singewald N. Magnesium deficiency induces anxiety and HPA axis dysregulation: modulation by therapeutic drug treatment. Neuropharmacology. 2012;62(1):304-312. doi:10.1016/j.neuropharm.2011.07.027

Snyder M, Trang D. Is EMDR effective in treatment of PTSD? EBP. 2022;25(3):14-15.

Terock J, Hannemann A, Janowitz D, Müller J, Völzke H, Grabe HJ. Vitamin D levels are associated with trait resilience but not depression in a general population sample. Brain Behav. 2020;10(12):e01884. doi:10.1002/brb3.1884

Terock J, Hannemann A, Van der Auwera S, et al. Posttraumatic stress disorder is associated with reduced vitamin D levels and functional polymorphisms of the vitamin D binding-protein in a population-based sample. Prog Neuropsychopharmacol Biol Psychiatry. 2020;96:109760. doi:10.1016/j.pnpbp.2019.109760