LUPUS – MENOPAUSE – DEPRESSION

This is a 48 year old woman who comes today with concerns over systemic lupus, depression and menopause.   She is a tall, large woman–very friendly and bubbly and very easy to talk to.   She is married and has two grown children.   She is a homemaker, and has not worked since being married, 25 years ago.

Case as presented on September 26, 2008

I remember being DEPRESSED for as long as I can remember.  No one would know it because I am so “bubbly”.  I think I was depressed–even as a child—I remember always being melancholy. My parents moved around a lot and I attended different schools often–like every two years.  I had everything I ever wanted, except that stability.   My parents were not expressive or affectionate.   I was not a responsible child.  My Mom did everything.  She was a perfectionist.  She would do things her way.   We would have to clean our room, but she would end up cleaning it again because it wasn’t good enough.  Never had to make my own bed—she would always do it for me.  They weren’t demanding, but were, in a passive or non-aggressive way.  In a guilt-ridden way.  Mom would make me feel GUILTY if things weren’t up to her standard.   Even though we got everything we wanted, Mom was extremely selfish.    I was telling her about our vacation the other day, and she butts in and tells me about herself.  Wait!  I wasn’t finished!   As a teenager, I was rebellious.

I do notice that I am worse in the wintertime.  I love the fall weather, but the thought of winter is not good.  I love the sunshine.   I don’t like the winter because it is cold and dreary.   I like the warmth and the sun.

Married in 1984.    Before I was married, I did work, was a travel agent.  Husband provides well for the family.

Daughter born in 1985.    The children were my life. Wrapped up in caring for them.   I am a little bit of both, laid back and yet want things just so.  I wanted them to have everything that they needed.  I helped out at school.   Had parties for the kids.    No one had a certain chore.  It was a group effort.

Son Born in 1988.   My son is a procrastinator, a lot of excuses.  I am more like my son. He has to be pushed to do things.   I am more like him.  I am totally like that.

The IRREGULAR and RAPID HEARTBEAT usually happens right around my period.  It is palpitations and irregular.  Seems to be more of a PMS type of thing.  It is really strong and irritating.  I had it for a long time.  For  years—have had it for about ten years.   (1998)

2003 on DEPRESSION MEDICATION.   Daughter graduated from high school.   Daughter was a senior.  That is when I really started to get depressed.  It was a feeling of not being needed any more.  Kids are off doing their own things with their friends.  Was a turning point as a mother for me.  You only have the kids for a little time in your life, and then they are gone.  You pour your heart and soul into raising them.  From the beginning of the year I went on a new medication because my depression was so bad. Couldn’t get out of bed.  Went two weeks without getting out of bed or changing clothes, etc.   Still have days when I can’t get out of bed because of my depression.   On a scale of 1-10 with 10 being the worst, I’d say my depression is a 5 and that is with still being on two medications.

HOT FLASHES started about two years ago and have intensified greatly.   (2006)   Anything that gets me excited throws me into a total sweat fest.   I have to calm myself down.   I sweat from the chest up.   I have them at least a couple of times a day.  If I have a busy day I have them more.   Definitely worse from excitement.  Worse from wine.   Any kind of nervousness going into a party, will totally set me off.   I have NIGHT SWEATS a couple of times a month and they are not that bad.

I felt good from 2003 – 2007 and then went into a different mode in August of 2007.    Daughter left at this time.  When I realized she had left, it was just really devastating.  Very DEPRESSED.   I felt like someone had just ripped my heart out.  It was later I felt angry.  I also felt disappointment.  I never felt like she didn’t love me, just that she was selfish.   I felt there was a lack of appreciation for all that we had done for her over the years.  “The little ingrate!”  I wanted to rip everything from her that we had done for her, like her car, etc.   I do have resentment towards my husband, for him not letting me take the car away.  I felt BETRAYED and extremely DISAPPOINTED.   I felt GRIEF.   I tell new parents to “not get too close to their kids—you don’t want to get hurt”!

SON WAS MARRIED two days later, August 2007.   Some relatives chose not to talk to me.  It was their choice.  I don’t really care at this point.  I am better off without them.   They don’t understand that my daughter is the only one that has changed.   It is hurtful, but on one hand I feel it is good riddance.

The JOINT PAIN is mostly in my HIPS and ELBOWS.  But my SHOULDERS have been tender.   My wrists also.  I have had a little bit of soreness in knees and ankles, but nothing like my elbows and hips.  When I breathe in deep, it is a burning feeling in my chest.   (2007)  It is a burning like I am really tired, like I’ve been running.  It lets me know my lupus is starting to flare up.  What made me really think of Lupus was I started getting PAIN in the HIPS.   The pain is stiff, sharp, achy. Inside and out and around my tailbone area.  It is constant.  There are other times it is much worse.  I do feel it daily, but I tune it out.   I don’t take any meds for the pain, I just live with it.

Dealing with MENOPAUSE.   In March of 2007, is when I noticed when things were changing.  I went four months without a period, then it was normal, then periodic.  This year I went three months without any period and since July 15^th, I’ve been BLEEDING on and off.   When off, still bleeding, but is not as bad.   The worst bleeding was last week for about three or four days I was going through a tampon every 45 minutes and a pad every hour with clots.   It was horrendous.  That lasted like that for 3-4 days.  I can usually go through a 48 pack of tampons in 3 months.  Now I go through a 48 pack of tampons in a week.  In the past have always been very light.  There are a lot of CLOTS.   They are dark clots.   No fibroids that I am aware of.   I have had CRAMPING.  I’ve never had cramps before.  Just a little discomfort.  The last 2-2 ½ months a lot of cramping.  I don’t take any meds for it.

My SHOULDERS AND ELBOWS.  My left elbow I can hardly use.  (2008)  The pain feels like arthritis.  Sometimes in the night it feels like someone is drilling into my elbows.  Achy and stiff during the day.  Muscles around it are very tender.  Feels swollen.   That is how it started–at night.  In both elbows, felt like someone was jabbing me with something sharp.   Right now the pain  is constant.

The FATIGUE is terrible. (2008)   I’ve never had fatigue like this.  Is almost like a deep painful fatigue/sleep.   Almost like being drugged.   Feel worse when I wake up then when I go to bed.   I have to take a nap every day, a couple hours long sometimes longer.   I start going downhill around 11:00 a.m.

Did have SUICIDAL tendencies this year (2008).  This is when I went on the Welbutrin.

I have terrible FORGETFULNESS.   I will even forget to turn off the water!   I forgot and was driving in the wrong lane!   Another time I put vagisil on my eyes!   Putting ice cream in the fridge instead of the freezer, etc. It is more like ABSENTMINDEDNESS.  (2008)

I was just diagnosed about two months ago (2008) with SYSTEMIC LUPUS, which is an auto-immune disease.  I think I have had it for a long time and just didn’t know it.

I don’t SLEEP very well.  I wake up every night at 3:33 a.m.   Doesn’t matter where I am.  I always wake up at this time.   I am up for a little while, about an hour and then go back to sleep.   I do not feel rested when I wake up.

I like things nice and neat and tidy.  It drives me crazy because my family is not always neat and tidy.   Husband has been gone for work and  I like being by myself.   I don’t need people around all of the time.  I do have a dog and a cat.  I love them.  They are my new babies.  I am very sensitive to the sun.  Need to wear sunglasses.  I feel “left-out”, sometimes…..I do not crave salt.  I crave more the bread and pasta.  I do like potato chips, though.

Initial Observations

This woman does appear to be responsible, but not overly responsible.   She does have strong feelings of attachment towards her children.  She deals with severe depression, rooted in feeling unappreciated, and has been suicidal in the past.   She does have feelings of guilt and also a history of wanting to “cut people off” or “out” of her life.   Although outwardly she is a very friendly, bubbly person, she prefers her quiet times and to be by herself, and many times does not want to be around people at all.   She is also dealing with much joint pain, apparently rooted in her emotional past, as well as excessive menstrual bleeding, both profuse and frequent and perspiration that is to an extreme–related to menopausal symptoms.

Rubrics using MURPHY’S REPERTORY

• MIND; Guilt
• MIND; Malicious
• MIND; Depression; from disappointed love
• JOINTS; Sore
• ELBOWS; Sharp, pain
• FEMALE; Menses; profuse and frequent
• PERSPIRATION; Profuse

Natrum Muriaticum           18

Aurum Metallicum             14

Ignatia                                10

Aurum-Mur-Nat                            7

Remedies considered

There were a number of remedies considered for this case, one being Aurum Metallicum.  This remedy was considered because of the need for the sun and the very severe depression that she is experiencing presently, as well as in the past.  Depression to the point of being suicidal, which is definitely a strong symptom that Aurum can express.  She also has strong emotional attachments to her children.  She says that her children are “my life”.   She was wrapped up in caring for them when they lived at home.   She also likes things “just so” and says she is a perfectionist, which is also an Aurum tendency.  Her parents were not overly affectionate to her while growing up, so there evidently was a lack of love shown to her and feelings of resentment because of it.   She also wakes up nightly around 3:00 a.m.—a time consistent with Aurum.  She loves the sun and the warmth.  In the repertorizing, Aurum came up strongly for the mentals and also fairly strong on the physicals—especially the joint pain.  Aurum was not chosen at this time because of the fact that there was not a strong enough thread of responsibility, but would certainly be one to consider as a second option.

Ignatia was considered because it did come up fairly strong on the repertorizing.   The mental rubric that was the strongest was the depression due to disappointed love, but had a poor showing on the physicals.  The remedy did not seem to fit her overall situation and how she expressed herself.  Although she did mention grief at times, it did not seem to be the predominant emotion.  This remedy was not chosen at this time.

Another remedy seriously considered was Natrum Muriaticum.  This remedy appears very strongly in the mentals in regards to the depression, the guilt and the feelings of resentment.   This is the emotional thread that I do see in this case.   This person is responsible on one hand, but on the other hand is also not responsible, and this can be a trait of Nat Mur at times.   She also has a thread of desiring to cut people out of her life, or not get too close to them, which is also a Nat Mur trait.  She is very sensitive to the sun.  In the repertorizing, this remedy came up very strongly in both the mentals and the physicals and it seems to fit her very well.  Strong on the joint pains and the perspiration, etc.   This is the remedy that was chosen at this time.

Remedy recommended at this time was Natrum Muriaticum LM1, 1 tsp/day, slowly working up to 2 succussions per day (due to the auto-immune disease she is dealing with).

1^st Follow-up on Oct 23, 2008:    She reports that her mind is much clearer and her depression has greatly decreased.  On a scale of 1-10, with 10 being the worst, her depression is at a 3.   On her own, she chose to go off of the medication Welbutrin, with positive results.   Starting to be more motivated.   Able to get out of bed more easily in the morning, but still taking a daily nap.   Body pain, including the shoulders, elbows and hips are not doing well right now—is really bad.   Hot flashes are dramatically improved.  No more perspiration. Not having them as frequently—just a few times a week as opposed to a couple per day.  When I do have them, they are very mild.   No more night sweats.   Burning in chest is gone.  All menstrual/menopausal bleeding and cramping is gone.  I have none.  Absentmindedness is better.   Sleeping better, still waking up, but now at 4:30 a.m.   Recommending that she stop the remedy for two days and then start on Nat Mur LM2, 1 tsp 3x/week at 1 succussion because of the body pain.

2^nd Follow-Up on November 20, 2008:   Body pain is good in the arms and hips.   The right elbow is 98% better than it was and the left elbow is 85% better!   The pain has had improvement overall and I am no longer individualizing my pain anymore.   The pain is nothing like it was!  Regarding my sleep, I no longer feel exhausted when I wake up.   Now sleeping all night and not waking up until 5:30 a.m.   No longer taking naps!  Even if I am tired, I still have energy to do things.  Motivation is so much better.   I even scrubbed the floors the other day.   No more hot flashes of any kind—not even mild ones.  I had a normal menstrual cycle with normal bleeding.  No cramping and no clots associated with it.   Perspiration is gone.  I do not feel depressed at all.  On a scale of 1-10, I feel I am a 2.   No longer on the Welbutrin, but still on Effexor.  Trying to wean myself off of that, but is hard.   Recommending that she continue onto Nat Mur LM3 and LM4, 1 tsp/day at 1-2 succussions.   (during a contact by phone moved her up to 4 succussions to help with body pain she was experiencing).

3^rd Follow-Up on February 5, 2009:   Body pain is excellent.  I totally have forgotten about any pain because I don’t have any.   It is all gone.   Sleep is good.  Waking up feeling rested and not waking up in the night.  Getting up at 7:30 a.m. and feeling rested.  Depression is good.   I don’t feel depressed.   No hot flashes.  Recommending that she continue on to Nat Mur LM5, 1 tsp/day at 4 succussions

4^th Follow-Up on April 2, 2009:     No hot flashes anymore.   Energy not so good right now.  Not wanting to get up in the morning.   Depression coming back a little bit.   Bleeding and cramping is fine.   Body pain is good.   Recommending that she continue onto Nat Mur LM5, 1 tsp/day at 6 succussions.  (increased succussions to help with energy and depression).

5^th Follow-Up on May 1, 2009:    I have so much energy I joined a gym!   I am walking and doing machines and all kinds of things.  I am at the gym for about an hour when I go.   My depression is very good.  I have been decreasing my Effexor medication and am down to a ¼ of a 75 mg pill.   No body pain.   No bleeding at all.   No hot flashes.  Sleeping like a baby!   I feel a lot better and am ready to get out of bed in the morning.   Recommending that she move onto Nat Mur LM6, 1 tsp/day at 6 succussions.

6^th Follow-Up on June 12, 2009 to present:    Doing very good in all areas.  Depression is good, energy is good, sleep is fine.  I have no body pain. No excessive bleeding.  When I do have a menstrual cycle, there are no cramps, no clots and just normal bleeding.    No excessive perspiration.  Recommending she continue onto Nat Mur LM7, 1 tsp/day at 6 succussions.   Since June, she has continued onto LM8, and LM9 at 6 succussions and is doing well.   Our next appointment is scheduled for January 2010.