Remitting long-standing major depression in a multiple sclerosis patient with several concurrent conditions

Abstract

In this report, we discuss the case of an multiple sclerosis (MS) patient, age 62, who learned to attain and sustain euthymia despite his ailments. He has Ehlers Danlos Syndrome (EDS), asthma, MS, urticaria, and major depression (MD). Despite thriving limitations, the patient is an accomplished scientist, who struggled for > twelve years to emerge from being confined to bed and wheel chair with MS, to walking with crutches, scuba diving, writing manuscripts, and living a positive life. Through former educators, he reacquired problem-solving habits to study the literature on his illnesses; keep records; try new therapies; and use pharmaceutical, nutritional, physical, and psychological methods to attain euthymia. With this inculcation, years later, he discovered that dimethyl fumarate (DMF) suppressed inflammation, cramping, urticaria, and asthma; and the combination of bupropion, S-adenosylmethionine (SAMe), vitamin-D3 (vit-D3), yoga, and self-hypnosis relieved MD. Then, after a 14-month respite, the patient, discovered that he had adult onset craniopharyngioma: a benign, recurring, epithelial tumor that grows from vestigial embryonic tissue (Rathke’s pouch) which formed the anterior pituitary. The tumor grows aggressively and causes surrounding tissue and function losses. It caused headaches, disorientation, bitemporal vision loss, among other problems. To emerge from this conundrum, the patient employed his relearned habits; the above antidepressant cocktail (bupropion, SAMe, and vit-D3); and with 30 fractionated stereotactic radiation treatments shrank his tumor and gained relief. This is a single case, and methods we discovered serendipitously may not work for other chronically ill patients. Consequently, we want to encourage such patients and their physicians to discuss their experiences in peer-reviewed domains so readers may acquire new perspectives that help individualize their care, and have productive contented lives.

Keywords:

• craniopharyngioma
• euthymia
• dimethyl fumarate
• bupropion
• S-adenosylmethionine
• vitamin D3

Acknowledgments

We thank Professors Bin Teh, Armen Kocharian, Steve Fung, and David Baskin, Radiation Oncology, Radiology, and Neurosurgery Departments, Houston Methodist Hospital for managing NS’s craniopharyngioma and associated problems; Professors Keki and Mazda Turel, Department of Neurosurgery, Bombay University for helpful discussions on endocrine and anatomic changes in MS, MDD, and craniopharyngioma; Dr James G Nadeau, US Food and Drug Administration, Silver Springs, MD; and Professor Naozumi Teramoto, Chiba Institute of Technology, Chiba, Japan for references, many insightful discussions, and editing and improving the quality of our manuscript.

Author contributions

Using his clinical records, NDS wrote and edited the entire manuscript. After reviewing his clinical records, coauthor AS focused NDS’s attention (between 2013 and 2015) on inflammatory triggers to help him manage MDD and helped with early editing. DEH was invited as coauthor because of his knowledge in neuroscience. He edited the first draft. All authors contributed toward analysis of the case and its clinical data; drafting and revising the paper; and all agree to be accountable for all aspects of this work.

Disclosure

The authors report no conflicts of interest in this work.