A Case Study
by Tim Shannon, N.D.
Female, 44 yrs old
Diagnosed Bipolar in 1982
S: I’m really tired when I get up, I’m really tired waking up – have to get up @ 5:30. Even if go to sleep early, after 10 hours of sleep, wake tired. I am manic depressive. I’ve been told this is a real hard time for people with this disease.
I’ve been having really disturbing dreams – I wake with them. Sometimes it’s so bad, feel like I’m having a bad acid trip. Had a dream that I’d died. First time I’ve ever dreamt that I’d died. The feeling – a little bit scary, b/c in the dream I’d died. It was a flying dream and I fell to the ground and I died. Ghosts are tied to this place and they are haunting. I was dead and people weren’t talking to me. I’m dead but I think I’m alive, no one could see me. Feeling of the dream? The after effect of the dream was apprehensive nervousness. This must be the definition of hell, haunting, being invisible. No one can see you. Most disturbing? I guess not being acknowledged, trying to talk to people and, not being heard or seen. And being stuck there and not transitioning to the next place. Make you think of anything else? The dream became a little clearer. The fear of being ignored, invisible, no identity, my presence is not acknowledged. What was significant about the dream, I was with an ex-boyfriend, it was a significant long term relationship. In the dream we died together. I’ve had recurring dreams about this man. I have no clue if he is even alive. In the dream we died together, laying in a coffin together. It wasn’t horrifying, in fact we’ were going to heaven. Went into different bars and restaurants and no one would respond to us. I thought I’ could just continue on living and I didn’t belong there anymore. I have been having a lot of strong dreams lately. To actually die, I’ve dreamt before of others dying. I feel like I have a problem with chronic fatigue. It seems rainy and dark and wet. I have very vivid dreams, very vivid. I have woke up with really bad cramps in my legs. I tried to walk and couldn’t even walk. I woke up and my legs were pulled back. Just had the one time, over 10 years ago had this problem with waking up with cramps in my calves. I talk a lot, I talk in my sleep, I have a very active dream life. Its like I lead two lives, the dreams. He says I make a lot of funny noises, moaning, sighing. It is like split personality. He says I’ll get mad of him and tell him off, in my sleep. Husband reports – I said you are snoring, and I said “I’m not even asleep, don’t bug me.” Been together 2 years I say, he says 3 years, seem to have lost a year somewhere. I’m a lot more outspoken when I’m asleep then when awake, Don’t really care what the consequences are. Used to walk in my sleep. Other things at night? The one about the dying dream stands out, it was so vivid. I have been having a lot of dreams about this former boyfriend. I dream that I run into him, dream that I run into him. Haven’t seen in 17 years, it is something that is unresolved. Haven’t made peace with that. Another, I’m down in California, and I’m stuck down there. Went down there in 1979, we were gonna get married, and I’d get a job. Was overwhelmed by southern ca, I just left – in 79. I have recurring dreams of Glendale – I’m trying to live down there. When I lived down there I dreamed of catastrophes. I didn’t like southern ca, it scared me. Always getting lost, they were so sophisticated, I’m not hip enough to live down here. I live in forest grove, and that is fast enough for me. If I’d stayed down there I’d live a very different live. Recurring of trying unsuccessfully, trying to get around, living there unsuccessfully. Other stuff. Dreams have always been very vivid, dreaming in color, always a mystery, a part of myself I’m not in touch with. It is a very significant part of my life. I dream every night. I had one recurring dream, constantly over and over and over about another guy. Ran into him, and the dream stopped. About? He was very successful, had a lot of kids, a high exec, I ran into him, he is a supervisor for delivery people for nickel ads. IN my mind he was so successful. I though he’d led this really beautiful life. Had these dreams about a year ago, – hadn’t seen him for 18 years. He was first boyfriend in college, ran into him, and it was kind of like, I had no illusions about hi mm, realistic. Everything kind of .. the idealizing I guess. He wanted to have 5 kids, I’ll never marry him. IN dreams he always has so many kids. I saw him and he only had one kid, didn’t seem too excited about it. IN a lot of relationships I’d missed the boat, I’d turn .. I’m a recovering alcoholic, I went down, I’ve had several bottoms. I bottomed out everywhere I went. I kept throwing it away, security, I’ was ending up somewhere stranded, high and dry, it was a nightmare. I always though of people in there houses and secure, I was traipsing around getting drunk and leading a meaningless life style. – going on adventures I was making a choice against love, if there was a relationship, I’d choose not. I’ve been sober for 5 years. AA have given me new life. I was so addicted to alcohol. I couldn’t imagine life w/o etoh. Had first drink @ 14, champagne. I though it was the best thing that ever happened to me, I want to stay drunk as much possible. I was at the same level as a skid row bum, I had the shakes in the morning. I always had etoh in my system. I was so addicted to the etoh. Jung said that you needed a spirit to overcome the alcohol. He said it very aptly. The people in etoh recovery had it right, the only thing that had hope was a spiritual cure, a spiritual awakening. I guess I must have had a spiritual awakening. I was like oxygen for me, etoh turned the light on . I was so sick I had such terrible shakes. I was so addicted it was at a cellular level. I am so petrified of alcohol. I don’t want anything to trigger. Cough syrup could trigger. It was such a monkey on my back. A lot of people thought I was an alcoholic of the hopeless variety. It was an obsession, it was so awful, it was all encompassing, in permeated my whole life. 5 years ago, the marriage fell apart. My alcoholism had deteriorated so bad that I’d become psychotic, I was too afraid to come out of my house. I would leave the house – I was afraid thought I was wanted for murder. Thought there were cameras, that my husband had put cameras, hearing voices, I know the definition of psychosis, I was so out of touch with reality. Went to psych hospital, and thought those people were so weird. Never in my highest of highs , I’ve have known extreme paranoia, This dog, I’d be out in the street, and thought would come after me. I had dreams about dogs, I dreamt these dogs had little thongs on, it was weird, didn’t realize they wore shoes. Another walking down street with black dog, and it talk I said I didn’t know that dogs could talk, It said sure we talk. Always loved animals. Into narnia and centaurs, and these animal fantasies.
Had a lot of dreams about dogs, they talk to me – English.
Menses? Regular, not anything unusual. 5 days of flow, 26-30. Color dark, like my clipboard. The week before I’m kind of crazy, the whole week before, I was really paranoid – having a severe dose of anxiety, paranoia has been the keynote – like I’m expecting, something terrible is going to happen to me or somehow else. Always breathe a big sigh of relief after it starts. Paranoid? I worry about my husband, he doesn’t love me, he’s sick of me, he’s carrying on with somebody else, about being poor, we’ve had a lot of wreckage we’re clearing up financial wreckage. We’ve been very poor last couple of years, rent going to get paid, have what we need. Worry about my mom, how much longer is she gong to live – 71. I’ve even worried about being homeless. We don’t have that high income. Not even having a dollar to go buy a coke. So I’ve been worried a lot about money. It has been real scary financially, if not pay rent, will we be out on the street. My friend got evicted, the landlord served her papers. I’d like to be as main stream as possible, don’t like red tape from section 8 housing.
Fears? Phobia about getting fat
Claustrophobic, have a lot of little fears, I had a phobia about driving again. I got a DUI, in 92, hit a woman, if she would’ve died, I’d have gotten manslaughter. I was so paranoid about driving, I doubted my ability to drive, so scary accident I was in. I was so paranoid about it, so scared to drive again Who in my age would be afraid to drive, now I’m driving. Now after sobriety, I have a life. Before I was totally bankrupt, at point of becoming a vegetable brain, amazing I can even think. I go through phases, I crave a lot candy. That sugar high, some say sugar is not a food, but a drug.
Animals? Love dogs, love my dog, little pug, so cute – really weird, so bull headed, strong willed. Pugs were companions to Buddhists in Tibet. Raised to be companions to Buddhists monks in Tibet. My little dog means the world to me, never had children, he is the wold to me. I’d love to have a bunch of dogs. I hat cats, I’m averse to cats, don’t trust em. If you leave them in the room with a baby they’ll jump them, how devious and wicked they are, one actually scratched me. Of course I hate rats, spiders and insects don’t bother me. Reptiles, – had nightmares that I saw snakes in my bed- had those dreams a lot when I was a child. Generally speaking I love animals. Snakes I don’t like em, never have to deal with them, they scare me.
Senses? My vision has become impaired, don’t see very well in the dark, for driving in the dark. Hard to drive in the dark, don’t see very well. Bright lights bother me, and loud,.. my husband is almost deaf, has the TV on real loud. The bright light is the most sensitive – over head light, like in my bedroom. Like subdued lighting.
Temps? You like warm, not hot. My husband turns up the heat so high – about 80. It is freezing outside. Would rather wear a sweater, then breaking out in sweat.
Foods? You like salty food, and also sweet food, deserts, candy and cookies and cake and pie. Seem to crave either salty or sugar. Like stuff pretzels, popcorn, and potato chips. Don’t crave meat much. Like coffee.
Don’t like real hot spicy food, hate that. Don’t even like Chinese food that is hot, makes you mouth burn. Likes Chinese food with soy sauce, or mustard – hot but not spicy. Like horseradish a lot too. Spicy Mexican don’t like, burns my throat.
Manic/depressoin?1982 – been in every psych ward in this city. I was acting really strange. I got picked up by police several times – in spring of 82. Was taken to OSHU psych ward. Strange? One time sitting in a woman’s car, she said what are you doing in my car, I said I’m trying to get it started. I though I was trying to pick out a car, I didn’t have one at the time. I was delusional. I started acting really funny, not sleeping, not eating. One time walking around in downtown Portland, thought I was a clandestine, a spy, and take down license plate numbers, I’d written down license plate numbers up and down my arms and legs. Had classes on CIA and intelligence agencies, I accumulated too much knowledge. I got out of college and then got mentally ill, fell flat on my face. 16 years of chaos and madness. No home life at all.
H/a? from working at Norm Thompson, wear glasses and now get migraines. This massive mental concentration. I’ve had problems with my head, migraines, bad h/a’s.
Imagination? Feel like I’d hear things, hear singing or music, someone talking. Think I’m hearing someone talking. Sometimes feel like I hear an oriental woman’s voice. I though it was spirit trying to contact me, astral realms. I thought I was psycho. I know I’m the only one that hears it. Husband is very grounded, calm cool, collected. I’m the opposite. Although I can keep my cool pretty well.
I don’t like the way I feel, I’m tired all the time, I thinking god I wish I have some speed, can’t use mind altering drugs, b/c it may lead me back to the bottle
Zyprexa 15 mg
Lithium 300 bid – on over a year – have gotten fat from lithium, nothing depresses me worse then when I feel fat. I weigh 153, I went manic last august of 98 – went off Meds, on Depakote and Wellbutrin, didn’t have $, lasted for 8 months then had a manic episode. I’m 5’7″ I got down to 135. I feel that I’m overweigh right now. I don’t like to take my lithium, if I wasn’t on lithium, I wouldn’t weigh this much. The mania is like being on cocaine, then you top over the edge, then you get into the paranoia, last time thought someone wold steal my dog from me. Thought someone would break into the house and steal my dog, I was so paranoid.
Efexor 20 mg – anti depressant
Prn – vicadan – hydrocodoneBefore I’d always run from things. I was even thinking of canceling my appointment, wanted to get home to see my dog. Always thinking about my dog, always think about my dog or husband, then I get resentful, have to take care of myself. I’ve realized after all theses years of running, and trying to hide, probably from myself, whatever it is that is making me feel anxious, depressed, and worried. Like to be move beyond them, and not be consumed by them. Like the idea that you don’t have to suffer from your own limitations. I am doing the best job that I know how to do, don’t’ like the results, if life is my laboratory, I don’t like the results, must be doing something wrong. Feel like I’ve been in relapse mode lately, been thinking about using speed but can’t do it.
A: DX: BiPolar, DDX: Delusional phenomena, hearing voices, paranoia
This patient has clearly not thrown off her alcoholism, She has many dynamics which show the tenacious hold that etoh has on her still. She has a very active dream life which should help to get a good rx. P:
Lac-c 30cQD to tolerance, then stop Summary of Follow-ups: I’ve followed this patient ever since. She has gradually reduced all her drugs and is only on Klonopin. She was switched from Lithium to tegretol about a year ago, and she tapered herself off that 6 months ago. The patient has suffered no manic episodes since starting treatment. In addition, besides her depression and other mood issues being much better, she also reports no more difficulties with PMS, back pain, bronchitis, or migranes. She experiences reduction in her anxiety and paranoia within the first 3 weeks of treatment and has not had any return since.
One great difficulty I ran into with this case was that I don’t have any prescribing priveledges for the psychotropic drugs she was on. Therefore I could not taper her off. I would have tapered her off the drugs much earlier. Her providers certainly would not do it, wouldn’t hear of it. So the patient began to taper herself off over the years. It is not the best way to work, but I have very little latitude in these cases. Especially when the family of the patient is opposed to alternative treatment, which was a problem in this case.
In any case, this patient responded very well to homeopathic treatment. It wasn’t only her bipolar that improved, but her whole general health, which is typical of homeopathic treatment. Incidentally, she took several different potencies during treatment of the same Rx. I’ve kept her on a low maintenance dose to date until she gets off the Klonopin. I’ve duly warned her to be VERY careful with the klonopin, given its tendency to yield powerful withdrawal symptoms.