16 year old female with Anxiety and Depression
A 16 yr old female came to the clinic with concerns of anxiety and depression. She also described "loose stools" and fatigue with energy levels at 2/10. Her anxiety was being managed by taking Ativan (Lorazepam) 1mg as needed.
In the office she was noticed to be more pale, with ridges on her fingernails and dry skin.
Labs were ordered and came back with :
1. Positive tTG IgG antibody: Tissue transglutaminase antibody (tTG), IgA class is the primary, most sensitive, and specific blood test — and the single test preferred by the American College of Gastroenterology and the American Gastroenterology Association for the detection of celiac disease in those over 2 years old. If positive, the test can also monitor the condition and help evaluate the effectiveness of treatment.
2. Low serum B12
3. Low serum vitamin D
4. Low ferritin
5. + IgG food sensitivities
Plan:
Referral for endoscopy
Gluten free diet
Multivitamin
DPP-IV enzymes: DPP-IV or dipeptidyl peptidase IV, is a form of digestive enzyme that breaks down common components found in gluten proteins.
Probiotics
Vitamin D
3 Month Follow up:
At the 3 month follow up, her GI symptoms had resolved. She was feeling more grounded but still needing to use Ativan 3-4 times per week. Her energy was increased to a 6/10, and depression symptoms were improving.
9 month Follow up:
At the 9 month follow up, GI symptoms were still resolved, anxiety was better and she no longer needed to use Ativan. Her energy levels were rated an 8/10, and she was no longer reporting depression symptoms. When the labs were retested both ferritin and vitamin D were within normal limits.