David, When I spoke with you on the phone during my initial interview, I remember me saying that if something is not working for the patient, you HAVE to change course. That patients oftentimes have a keen sense of what may or may not be going on in their bodies. so... My little patient, who I've been concentrating on treating for anxiety and high cortisol, is needing a change of course. I'm thinking a completely opposite change of course. I've always thought of anxiety as a heightened state, and depression a lowered state. Is it possible that the anxiety is actually stemming from a depressive state? I think I may need to focus on helping treat her with moderate depression as well as ADD. Could you also provide me some guidance regarding Lemon Balm for depression and thyroid contraindications...Her most recent labwork on thyroid is as follows: Free T4(direct) 1.49 Free T3 4.0 Reverse T3 18.2 (Range 9.2-24) TSH 2.4 No autoimmune antibodies AM cortisol 25.2 B12 503 LOW The one thing standing out to me is that her TSH should be a lot lower with her Free T3 and Free T4 levels being where they are. Which may indicate receptor sites clogged with RT3 and/or cortisol. High blood circulating hormone, but low thyroid hormone in cells? Under these circumstances, would including Lemon Balm in a mixture for depression be a wise choice? Needing some direction:)

First it depends on how long you have tried a protocol and the compliance level before you consider changing things, as well as what the problem is. Some things resolve quickly, other can the a very long time. Is it possible that the anxiety is actually stemming from a depressive state? There is mixed depressive-anxiety disorder, where you have both conditions. I think I may need to focus on helping treat her with moderate depression as well as ADD. Both depression and anxiety are common co-morbidities of ADHD. I would avoid large amounts of Lemon Balm with hypothyroid conditions, small amounts are not an issue, it is indicted for mild depression, so a tea with Mimosa flower (1-2 parts), Linden Flower (2 parts), Lemon Balm (1 part), Lavender (1/4 part) or something like that might be useful. While the TSH is slightly above optimal, it is not indicating nor the other thyroid values thyroid dysfunction. it could suggest low levels of Iodine, Selenium or zinc.