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- Feb 8, 2004
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Got a patient that was already seen by a great clinician and she couldn't get this patient better. Was tried on all the conventional meds. A few SSRIs, SNRIs, Lamotrigine, Lithium, atypical antipsychotics (and yes the better ones for depression such as Aripiprazole, Cariprazine) , Bupropion, augmentation agents such as Buspirone, Auvelity, Esketamine, TMS (not ECT...yet).
After several meetings she finally said something that hit me like a ton of bricks. She told me she never had mental health problems until she was bitten by a snake years ago.
So given that she never had depression until the snake bite and from there on several health problems including depression and syncope, I did a lit search. Unfortunately almost all of the snake bite data is only focused on acute treatment. There are very few articles on long-term outcomes of snake bites and adding to the problem the long-term issues seem to vary depending on the type of venom depending on the snake that bit the person.
The only thing I've been able to see as a pattern is some patients post-snake bit suffer from hypopituitarism. The problem here is I seem to know more about it than her PCP who hasn't done any lit searches so I'm going to contact the PCP and recommend an endo-follow up but other than this I don't know what to do.
MY theory is the snake venom did something permanent to the patient and not simply just PTSD. She's not c/o PTSD sx. She has severe depression with extreme insomnia but no PTSD nightmares, flashbacks, triggers. I'm theorizing the venom did some type of neurotoxic effect on her that caused long-term depression. The problem here is the lack of data to back it up other than the circumstantial evidence, and the lack of evidenced-based data.
Anyone have any experience with long-term effects of snake bites?
After several meetings she finally said something that hit me like a ton of bricks. She told me she never had mental health problems until she was bitten by a snake years ago.
So given that she never had depression until the snake bite and from there on several health problems including depression and syncope, I did a lit search. Unfortunately almost all of the snake bite data is only focused on acute treatment. There are very few articles on long-term outcomes of snake bites and adding to the problem the long-term issues seem to vary depending on the type of venom depending on the snake that bit the person.
The only thing I've been able to see as a pattern is some patients post-snake bit suffer from hypopituitarism. The problem here is I seem to know more about it than her PCP who hasn't done any lit searches so I'm going to contact the PCP and recommend an endo-follow up but other than this I don't know what to do.
MY theory is the snake venom did something permanent to the patient and not simply just PTSD. She's not c/o PTSD sx. She has severe depression with extreme insomnia but no PTSD nightmares, flashbacks, triggers. I'm theorizing the venom did some type of neurotoxic effect on her that caused long-term depression. The problem here is the lack of data to back it up other than the circumstantial evidence, and the lack of evidenced-based data.
Anyone have any experience with long-term effects of snake bites?