Medical Literature

Is Zoloft good for DID (dissociative identity disorder, f.k.a. multiple personalities)?

QUESTION:

Dear Dr. Heller,

Is Zoloft good for this problem?  I just started taking it and I wonder if it will help.

Thank you.

ANSWER:

I’ve taken care of some DID patients, and every one of them also had the BPD (borderline personality disorder).  If the BPD is present I’ve found Zoloft to be significantly inferior to Prozac, although it can work for some patients.

While all the principles of treating the BPD continue for those with DID, I have found some additional things can be done…

1. Make sure the Tegretol blood level is therapeutic, preferably in the upper third of normal. 
2. Add Remeron for the PTSD and sleep. 
3. Make them safe.  Having a good dog and an alarm system with motion sensors can make a huge difference. 

 

2001 September Questions

 

Ask the Doctor

 

Home

QUESTION:

Dr. Heller,

Hi, I  am a 20 y/o female recently diagnosed with Bi-polar Disorder.  When I looked at your test at the homepage, I could answer yes to most of the questions, all but three.  Does that mean that I have ALL those things wrong with me???

ANSWER:

Absolutely.  There’s no reason they can’t all be present.  Having the OCPD is actually an advantage because these people tend to be motivated.  You’ll need to see if all those diagnoses are present, and get them all treated.

Can You Help a Desperate Man?

QUESTION:

Dear Dr. Heller,

I am a 45 year old Caucasian male. I am in my 4th marriage. I have been a successful, and a not-so successful, entrepreneur all of my adult life, with the exception of the Army and College. I have started a river rafting, horse backing riding guide service that I grew to guide 14,000 people a summer while in college, I’ve been a very successful stock broker, and a little over a year ago I sold a software company I started for over $1 million.

My wife and I are on the verge of an extremely bitter divorce. I have 3 felony charges hanging over my head for domestic violence which will probably mean 6 months to 2 years in jail. My wife recently read about Borderline Personality and believes that might be my problem. I read your discussion on it and I am convinced it is. I have seen 4 doctors and two anger counselors in the past 2 years. I’ve been on Celexa (40mg then 20mg off and on for a period of 3 months), Lithium (1 week, it made me sick), and Xanax (3 days and I flipped out, plus it made me sick and dizzy). Nothing seems to be working.

I am a very desperate man at this point. I am scared beyond bearing it of getting worse in jail with no counseling or treatment, having my marriage fail, and losing all of my net worth. I’ve also recently had my mother die, and went thru another divorce just two years ago. I am at the end of being able to think about how to fix this. Please help with some advice. I have health insurance that can pay fees that might be involved. But time is running out for me and You are the only source on this subject that has put it terms that I can see relates exactly to me. Please email me back if you can help.

Thank you so much for your consideration.

 

ANSWER:

I appreciate your kind words. It seems just like the wrong combination of medications. You’re living proof how some individuals with the BPD can be extremely successful in some areas of life, but have horrible problems in one’s personal life.

I would be happy and honored to see you. I firmly believe that my approach can make a profound difference for you and your home life. Please fill out the screening test I use for my patients in advance. Please also review the information about coming to see me. Please understand however, that I want you to determine who you want to be and how to get there rather than dwelling on why things are the way the are. It’s the present and future that matters.

 

2000 January Questions

 

Ask the Doctor

 

QUESTION:

Dear Doctor,

I was diagnosed many years ago with dysthymia and had severe insomnia.  I’ve always been depressed even as a child.  I’m 55 years old now.  I took 20/40mg of Prozac for about 10 years and it helped tremendously.  For about the final 2 years on Prozac, it seemed to “poop out” and fatigue started setting in.  All I wanted to do was sleep.  I went all the way up on dosage to 80mg/day on the Prozac with no improvement.  Feelings of “fear” of job, life, etc., preoccupied my mind.

Not having the money to continue visiting a psychiatrist, I’m trying to solve this problem medically myself.  I think I’ve read your entire Website trying to see if the fact that I had no adverse affect with taking Prozac rules out me having the GAD.  I haven’t seen that specifically addressed.

As I’ve said, I’ve developed a great “fear” of getting thru life and being able to handle my job.  Assuming the constant “fear” may be the GAD, I’m taking 15mg/day of BuSpar and 40mg/day of Paxil.  I’ve been on Paxil for 2 months (still having constant fear though it seems to have helped my depression) and just started 15mg of BuSpar for a week now.  Do you think I am headed in the right direction?  Can the constant “fear” of life be something other than the GAD?  The fear seems to be related to anxiety in my view.  What would you recommend?  Is the BuSpar a waste?

You have a wonderful Website.  You have a unique sense of logic that I like being an engineer myself (i.e.  SSRI’s increase agitation with the GAD, etc.).  You don’t take a shotgun approach to solving mental disorders.

Thank you.

ANSWER:

The two main reasons Prozac “stops working” are the BPD with chronic dysphoria (anxiety, rage, depression and despair) and an imbalance of too much serotonin with a relative lack of dopamine and noradrenaline in the brain.  This resolves with the addition of Wellbutrin.

If BPD dysphoria (anxiety, rage, depression and despair) is the problem, the addition of Tegretol usually makes the problem go away.

Not all patients with GAD have their condition worsened by SSRI’s.  The main symptoms I look for with the GAD are persistent worry, mind always going, and chronic fear.  The GAD is usually genetic.  If the GAD is present, BuSpar will make a huge difference.

I cannot overemphasize the importance of making all the diagnoses and treating them comprehensively.  The screening test may be of use to you in this regard.  The dysthymia you describe is likely what I call “fractured enjoyment” – and used to be called the depressed personality disorder in the 1920’s.  Prozac is usually a miracle medicine for these individuals.

QUESTION:

Dear Doctor Heller,

A couple yrs prior to being Dx with BPD, I was treated for depression {also have major depressive disorder} with Prozac. It lifted the depression, but after 3 months of taking it I started having “racing thoughts”. Since then I have been Tx with Wellbutrin for the depression, but was unable to rest at nite so Zyprexa was added HS. After my last suicide attempt, both of these were discontinued and I have been on Seroquel for the last 4 months. The depression has returned, as well as psychotic behavior. The “thoughts” and psychotic behavior disappear usually within 20mins of taking my Seroquel. My question is: To alleviate the depression, would it be wise to start taking the Prozac again or Wellbutrin.

I am currently searching for a doc, as I have re-located. Until then, I was wondering what your opinion is regarding the medication issue. I was diagnosed BPD a year ago and am legally disabled. I am also a nurse and have “some” extensive knowledge re: meds. And yes, I know it is imperative that I find Tx ASAP…

Thank you.

 

ANSWER:

What you likely experienced 3 months after beginning Prozac was a dysphoric episode – which would have been more successfully treated with Tegretol. As needed, Seroquel is a good option, particularly since it works for you within 20 minutes. My medication sheet will likely be of use to you, as will my dysphoria instruction sheet You also need to do the screening test ASAP so you can get everything treated comprehensively. Wellbutrin is a good adjunct for persistent depression problems, and it’s great for assisting with smoking cessation, but in my experience it’s not a great medication for the BPD.

QUESTION:

Dear Dr. Heller,

I have been diagnosed with depression for at least 10 years now but suspect I have been ill longer. I have been to three or four hospitals within that time. I have just spent seven days in the psychiatric wing of our county’s biggest and best teaching hospital–diagnosed as possible manic depressive. I have been prescribed Depakote (so far only up to 750 mg), and trazodone (50 mg).

Do you agree or disagree that this is a good combination, and if so, how long will it take to start noticing a difference or feeling better?

Thanks in advance for your answer. Love Always Wins!

 

ANSWER:

The screening test I use for my patients may be invaluable to you. I have a section explaining the Borderline Personality Disorder (BPD) and many other common disorders in this website, and they’re all discussed comprehensively in my book “Biological Unhappiness.”

I’ve seen many, many individuals who have been chronically depressed for years and years. The usual answer is the BPD combined with additional diagnoses. Bipolar can also be present, but you’ve obviously not responded so a look at other options seems reasonable.

I strongly recommend you find out what your diagnoses are so they can be comprehensively treated. Unfortunately, many in the mental health profession don’t believe in the “Borderline Disorder” – which can profoundly hamper treatment.

Regarding medication, Depakote can be useful for bipolar and the BPD, although side effects are often a problem. Dose doesn’t matter, blood levels do. Trazodone–particularly at that dose–in my experience isn’t that useful.