Medical Literature

QUESTION:

Dear Dr. Heller,

My daughter lies to me all the time.  She also has other problems.  For instance, she can make herself believe that her behavior is warranted.  If she wants to do something she will do almost anything to get to do it.  She has had 2 relationships w/ boys.  Both were VERY destructive to her self worth.  She has always been a pleaser, she used to want to please myself and any other adults in her life, but now she shows that same desire but it is toward her friends (boys and girls).  She seems to show no remorse unless she gets caught lying, but even when she knows she is caught she will argue her case even if she knows how hurtful her lies are.  She will perpetuate it to get herself off the hook or confuse me enough that I will drop it.  Also, if she thinks she isn’t getting her way she will try and do something to make me mad at my husband (her stepfather), so that I will jump on her side, feel sorry for her and give in to her wants.  (I am sure you realize this has worked for her before.)

I will admit that I was very protective over her when she was younger.  I think after she got to be around 13 she and I broke away from that but she still knows I won’t let anyone harm her.  She is now 17 years old, she got pregnant last year by her 2nd boyfriend.  She didn’t tell me.  She did tell him and all her friends.  She even told them that I knew.  She lost the baby at 3 ½ months.  She had dropped out of school 1 ½ months before she lost the baby and started in a private school.  After she had problems there she went back to her high school.  It seems as though everything she has ever been involved in, she somehow becomes a victim.

Her friends always pushed her around although she has gotten better about that.  She has a very large heart and although she doesn’t show remorse in her actions, she shows disappointment in her life.  She has no idea how badly her behavior effects her self worth.  She insists on not making the tough choices in life.  She wants what she wants when she wants it.  She is a master at manipulation.  She smokes cigs and drinks some but she doesn’t use drugs or sleep around.  She is very afraid of the unknown.  She is steadfast loyal to those she loves.  She shows very little interest in anything other than her friends.  It seems as if she is searching very hard for happiness outside of herself.

When she was 6 years old I had a therapist tell me she was the youngest codependent she had ever seen and that when she turned 13 she would be worse than I was.  I am a codependent but I am much better than I was before.  Her father is an alcoholic, he hasn’t been in her life much.  I did protect her from his behavior as much as I could without drawing attention to his problems.  She always felt sorry for him until he broke a promise he made to her when she was 13.  She told him “DADDY, YOU DON’T HAVE TO SPEND ANY MONEY ON ME FOR X-MAS IF YOU’LL JUST BUY MEGAN A PAGER.”  (Megan is her little sister.)  Up until then she never made him accountable for anything.  But instead of buying the pager, she overheard him and his mother arguing over his crack-head girlfriend that needed  to be bailed out of jail.  He bailed her out.  She has never forgiven him.  She says she doesn’t care if he lives or dies.  It was always okay for him to hurt her but her made a very big mistake and hurt her sister.  I hope you can help me to help her.  I get so angry sometimes and so depressed I just don’t know how to help her.

PLEASE HELP ME.

 

ANSWER:

You’re obviously going through a horrible time. The principles remain the same… 1)    Do the screening test for her and for you and her father, and possibly other siblings.  Genetics plays a tremendous role.  2)    Get her treated medically ASAP!  Nothing will likely be successful without the medical problems treated. 3)    Fet her and you counseling ASAP! 4)    Consider going with her to a weekend seminar such as Zig Ziglar’s Born to Win, or Barry Neil Kaufman’s Option Institute

QUESTION:

Dear Dr. Heller:

My daughters hypothalamus was damaged after debulking a tumor.  Almost three years now we’ve been battling a constant appetite.  She’s currently taking other medications, cortef, Synthroid, DDAVP and BuSpar.  Is there ANYTHING out there that she could take to suppress her appetite?  If so, please respond.

 

ANSWER:

Some medications can indeed suppress appetite including Topamax and higher doses of Remeron.  Meridia is an appetite suppressant as well, but a poor one.  I’d highly recommend doing the screening test I use for my patients to see if there are any diagnoses present that need treatment.

If nothing shows up, a visit to an academic center that specialized in appetite seems to be in order.

QUESTION:

Dear Dr. Heller,

My son has had emotional problems most of his life. He’s 19 years old. His father is an alcoholic, and could go into a rage from time to time, but manages to hold onto a very good job. My son’s problems seem to be that he can’t get along with people and will do things to get them angry at him.

He went to live with his father for two years and during that time got into so much trouble. He started stealing from his father and then from a friend’s father and got caught. He was charged with three felonies for check forgery. When he came back to me he was so out of control. Cutting himself, stealing, lying. Doing really strange things to get back at me if I disciplined him. He couldn’t sleep. Would steal my car and drive all night long. I took him to a psychiatrist and he said he has BPD. He started him on Risperdal. Then I took him to another doctor who put him on Depakote. Now he’s on Depakote 500 mg in a.m. and 500 in p.m., 4 mg Risperdal, and 20 mg Paxil. He’s groggy most of the time and has gained about 100 pounds. It’s so sad. So the doctor suggested Neurontin instead of the Depakote to lose weight. He just started that the other day and last night he said he was feeling suicidal and felt like cutting himself again. The doctor said give it two more days and then if no better would put him back on the Depakote. But the weight gain is horrible! Does this sound like BPD? I would like to try him on your plan of Prozac and then Tegretol. Does Tegretol have the weight gain associated with it like Depakote, or is the Risperdal causing the massive weight gain?

 

ANSWER:

The BPD sounds like a likely diagnosis, although I’m highly suspicious AD(H)D may be present as well. I strongly recommend doing the screening test that I use for my patients – and for both you and the boy’s father to do the test to see what diagnoses you have in common. Genetics plays a very powerful role. Treating all the diagnoses comprehensively is crucial. I’ve never been impressed with Depakote. It just doesn’t work that well for most patients in my experience. Tegretol is generally far superior. Unlike Depakote, Tegretol doesn’t cause weight gain unless it also causes low thyroid (which can of itself cause weight gain but is easily treatable). Risperdal and Zyprexa can cause profound weight gain. I prefer to use Risperdal only during the most severe crises, suicidal spells, and during severe dysphoria (anxiety, rage, depression and despair). Neurontin can be a fair second or third choice for a mood stabilizer, but it rarely works. I also haven’t found Paxil to be as effective in treating the BPD as Prozac is, but it is a reasonable second choice. Paxil can profoundly worsen irritable bowel syndrome in some patients.

Do I Really Need BuSpar Or Is Luvox Alone Enough?

QUESTION:

Dr. Heller,

I find your web site fascinating.  Question: I have just started taking Luvox to help me with my social phobia, depression, and worst, my unstoppable obsessive thinking patterns.  it has been very helpful (I had tried everything else).  I was also on BuSpar 40mg a day.  My doc said I could back off from the BuSpar cause I was feeling a little too hyper.  Do you think Luvox alone is ok (so far so good) or does the BuSpar help?  I prefer not to take the BuSpar-it seems to make me edgy!  I seem to flip flop between being calmer and more agitated with it.

Thanks

 

ANSWER:

It depends upon the diagnoses.  If the generalized anxiety disorder (GAD) – particularly the cognitive component – is not present, then you don’t need BuSpar.  The GAD is a genetic trait that I often refer to as a “cave guarder.”  I explain this in the book “Biological Unhappiness.” All the SSRI’s can work for social phobia, depression and obsessive compulsive problems.  I rarely prescribe BuSpar above 15mg twice daily.  If the Luvox is working, fine.  If it isn’t a re-evaluation is needed.  The screening test I use for my patients may be helpful in this regard.

 

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