Case Study: What Caused this Sea Captain’s Panic Attacks?

By Dr. Elissa Mendenhall N.D.

Meet my patient Ronnie. A retired sea captain in his sixties, he’s a cheerful and optimistic man. On first impression, you would never guess that he had been experiencing multiple panic attacks each day since before he was 16 years old. By the time he arrived in my office, he had been suffering with daily panic attacks for some 50 years.

Although he led a productive and active life and career, his panic disorder very much impacted his quality of life. In the past, he had tried a variety of anti-anxiety medications, such as escitalopram and fluoxetine, but he found no relief from them.

Ronnie also had an inflammatory bowel disease, collagenous colitis, which was symptomatic to some degree most days of the month. When it was very active, he would sometimes have 30 bowel movements a day. There were a number of foods and nutritional supplements that he couldn’t tolerate because they triggered diarrhea or painful cramping. In addition to the panic attacks, Ronnie had been having episodes of depression for days to weeks at a time without a known cause.

What Was Causing Ronnie’s Issues?

I postulated that Ronnie’s bowel disorder was increasing brain inflammation. In addition, the medication he was taking for the bowel disease—budesonide—was helpful at relieving his symptoms, but I was aware that it is in the glucocorticoid family of medications, known to trigger depression and other psychiatric issues.

I told him that it was possible this medication could be causing depression. That’s when we started tracking the times when he took the medication. Our sleuthing revealed that the times he was depressed did, in fact, correlate with the times he was using that medication.

Finding a Path to Healing

Pinpointing the medication as a contributor to Ronnie’s depressive episodes was only the first step. We also tested for hidden food allergies and changed his diet, which cooled down the inflammation in his brain and his digestive tract. After he changed what he was eating, not only did his bowel disease go into full remission for several months, but his panic attacks also became far less frequent. With his dedication and my guidance, he was able to reduce and eventually almost eliminate the use of budesonide, which resolved his depression.

The next step involved pharmacogenetic testing and found that he was incompatible with SSRI antidepressants and several other classic antidepressant medications. In fact, he had a genetic marker that is common in people with bipolar disorder. Even though he did not meet the diagnostic criteria for bipolar disorder, his psychiatric prescriber saw the results of the panel I’d ordered and suggested he try a mood stabilizer medication (lamotrigine). With this, Ronnie’s panic attacks stopped altogether.

I had the privilege of working with Ronnie over the course of the next several years. During this time, he remained stable with only a few flares of mild anxiety and gut issues. Finally, after five decades of struggling, he was able to focus on the retirement and life he had envisioned. Freed from the grips of anxiety and disease, the sea captain ventured out to new horizons and began traveling the world with his wife. 

About the Author: Elissa Mendenhall, ND, Amen Clinics San Francisco Bay Area

Dr. Elissa Mendenhall, ND practices at Amen Clinics, which offers in-clinic brain scanning and appointments, as well as mental telehealth, remote clinical evaluations, and video therapy for adults, children, and couples. Dr. Mendenhall is a naturopathic doctor who can prescribe both natural and prescription medications.