Medical Literature

QUESTION:

Dear Dr. Heller,

I am 25 years old and have just recently been diagnosed with BPD.  Although I was in therapy for the past 8 years because of my symptoms I was never brave enough to be totally honest and get the diagnosis I needed until just a few weeks ago.  My first major symptom was very persistent, and sudden disassociation, then anxiety mixed in, and now for the last 3 years it has been intermingled with intense anger.  Of course my personal relationships are terrible, etc.  I fit all the categories except self mutilation and suicide attempts/threats.  My coping/self harming mechanism was sex.  I have recently been prescribed Neurontin for my anger and am waiting for the weekend to try it.

In your Website (and book) I read that my symptoms mentioned above are conducive to Epilepsy.  Is THAT really what has been wrong with me for 8 years?  Can you explain the connection to BPD a little better?  I also have a goiter, although my TSH levels are fine, I take Levoxyl to reduce the size – is it possible that a thyroid problem really is affecting me even though my TSH levels are fine?  Do you offer any workbooks for those of us who do not live near your practice??

I consider myself high functioning and have really wonderful qualities that get so masked by BPD – I have waited 8 years for a diagnosis and now that I have it I am so eager for a clear understanding and a “cure”.  I pray for the day that my “fog” disappears!!!!!!  I am eagerly waiting to get a grip on my professional career and it is so frustrating to know that I’m not at 100%, 100% of the time!

Also, I do not remember any sexual abuse in my past – although sex was my motive for control.  Does that imply sexual abuse?  Also, I lived with a step mother from the age of 11-15 that could so easily be defined with BPD – she was mean and I was terrified the whole time I lived with her – could that have been the cause??  Is it about finding the cause or as you say “reprogramming the brain”?  I understand that concept completely – I dealt with some pretty intense anxiety and learned to reprogram myself then, instead of dealing with side affects of medications (Prozac drove me absolutely crazy!!!)…is it the same concept??

I’m sorry to babble – I hope you have time to answer all of my questions.  I am grateful for your Website!  I hope someday to publish a book that I have written of my life and all the situations I found myself in.  I never could find a way to end it because it seemed to just continue in the same pattern no matter how aware I was.  Surprised as I was, it can end now with a diagnosis of BPD.  Although, I hope to add one more chapter called “Recovery”.  I had always thought it would end that I would find a wonderful man or win the lottery and my life would then be wonderful…I never would have guessed this disorder was at the root of all my evil!!

God Bless you!

 

ANSWER:

1)    Yes, I believe the BPD is primarily a form of epilepsy. 2)    The BPD is commonly associated with thyroid problems, although goiter isn’t one of them.  3)    I do not have any workbooks, but it’s an excellent suggestion.  4)    What you described doesn’t mean sexual abuse, although it doesn’t mean you weren’t.  5)    You need the right medications.  If Prozac made you ill, you likely also have the GAD and need BuSpar.  Please take a look at the screening test and the FAQ section in “Ask The Doctor”.

QUESTION:

Dear Dr. Heller,

What is your prescription for dysthymia?  A family member was diagnosed with it and on Effexor for a few months.  The Effexor worked effectively but the person will no longer take it.  Instead they are taking St.  John’s Wort.  I think a prescription is necessary to get the desired results, but they refuse.  Any suggestions?

Thanks for any information and your web site is very informative.

ANSWER:

To me Prozac has no equal for dysthymia.  It’s also crucial to make all the other diagnoses and treat them.  Anxiety and other problems can be somewhat depressing, which can trigger dysthymia.  The screening test I use for my patients may be of significant use to you.

Dysphoria & PMS

QUESTION:

Dear Dr. Heller,

I am a 41 year-old woman who has been diagnosed with BPD for over three years now. My current drug regimen is 60 mg a day of Prozac and one 150 ml Wellbutrin per day. Complications: I have been diabetic (using glipizide) for over 10 years, do not control my diet well, don’t exercise much, am about 90-100 lbs over my ideal weight. At some point I realized that in the week before my period, I often had one day of terrible rage or sadness. As I’m getting older, I find that there seems to be more and more a correlation between dysphoria levels and the time after ovulation and before my next period. The durations and intensity vary, but it seems to me my worst dysphoria is at that time, usually in the week before my period. Last week for example, I cut myself twice (more than in a long time), then suddenly felt sane again Tuesday, and my period started Wednesday. The difference is remarkable… it feels like I push through a glass wall and find sanity again, though I don’t realize while dysphoric how dysphoric I am. Do you see in your practice ties between BPD and the menstrual cycle, and particularly changes with premenopause? Is there anything I can do to lessen the dysphoria in the premenstrual period? I see you recommend Tegretol a lot… do you think it would be better for me than the Wellbutrin? I think I feel more stable on the Wellbutrin, but it has not stopped the dysphoria from being particularly bad lately, triggered by a change in a relationship. Many thanks..

 

ANSWER:

There is a direct correlation between PMS and BPD dysphoria. My patients no longer have a problem with this due to a safe and effective treatment for the underlying problem in PMS – fluid retention causing brain swelling. I explain PMS, particularly in those with the BPD, in my new book “Biological Unhappiness” (http://pks.947.myftpupload.com/order.htm) and there is a true story in that section which will describe you perfectly.

Mid-cycle dysphoria usually means either cyclothymic disorder is also present or the temporary drop in hormones is triggering the same phenomenon as PMS. In my practice, I recommend trying the same treatment for this mid-cycle problem as for PMS. A very reasonable option at your age is continuous hormones to prevent these terrible mood swings. The above 40 age group has the most abortions, and whether you are “pro choice” or “pro life” – all agree preventing unwanted pregnancies is the best option. Early menopause causes severe irritability which can be deadly for borderlines, and it’s clear treating menopausal and post menopausal women with estrogen replacement has an incredible benefit, particularly for those prone to depression.

Smashing your fist through glass and injuring it is very much like scratching a severe itch – it temporarily relieves the horrible sensation, but injures the body. There are safer and more effective ways for you to “restore my sanity.” http://pks.947.myftpupload.com/dysphori.htm

I have enormous respect for what Tegretol can do for BPD individuals with dysphoria, both in treatment and prevention. An option I would give my patients in this regard is to take Tegretol at night only, a few days before mid cycle and before the PMS time.

I rarely prescribe Wellbutrin anymore since, to me, better options are available. It’s also being used to help folks quit smoking under the brand name “Zyban.” Since recent data seems to indicate Wellbutrin is not significantly better at not causing mania, I don’t perceive a real good reason to use it in my practice. It’s used in combination with SSRI’s for sexual dysfunction, but in my experience is rarely successful. Ginkgo is usually more successful, and you can read about it at ../Ginkgo.htm.

My “How I Treat the BPD and Why” may be useful to you as well. It’s located at: ../HowBPD-Y.htm.

QUESTION:

Dear Dr. Heller,

Great relief of chronic depression from Zoloft for 3 years, then effectiveness decreased by 75%. Have any other drugs been shown to pick up the slack in this situation?

Thank You

ANSWER:

The two most common causes for this are:

1. BPD (Borderline personality disorder) with chronic dysphoria (anxiety, rage, depression and despair). The depression of dysphoria is neurologically different than regular depression.
2. An imbalance of serotonin with noradrenaline and dopamine. SSRI’s like Zoloft raise serotonin and a relative imbalance can occur. Adding Wellbutrin usually solves the problem.