Medical Literature

QUESTION:

Dear Dr. Heller,

Thank you in advance for looking at my question.  Up until a few years ago, I hadn’t experienced anything like a panic attack.  Then, after many upsetting events happening continuously in my personal life throughout the last 2 or 3 years , I developed brief, sporadic anxiety attacks.  In the last year specifically, I grew increasingly unhappy with things not changing in my personal life and eventually developed an immune dysfunction illness (something like chronic fatigue syndrome) with one of my worst symptoms being a daily upset stomach.  It is my assumption that the constant stress helped lead to these various symptoms manifesting themselves.  The doctor I am seeing has helped almost all of my symptoms, but my nausea will not go away and tests aren’t showing anything wrong.  This doctor thinks anxiety may be the culprit.  In addition, I have seen a counselor who has diagnosed me with GAD.  I am extremely affected by my stomach and am unable to do almost anything I could do before this upset stomach started (had to quit my job, nervous while driving, etc.).  I finally started BuSpar 5 days ago with my doctor’s recommendation.  I was reluctant to try it because medications like these frighten me.

Anyway, is there hope for a case like me?  From your experience, do you think BuSpar could have enough of a positive effect for me to maybe start getting my life back – BuSpar combined with counseling, that is?

Thank you!

 

ANSWER:

If the GAD is your only diagnosis, yes, BuSpar can help you enormously.  The effective dose is usually 15mg twice daily.  If the BuSpar makes you ill, the addition of Remeron could be of enormous help.  I always recommend treating all the medically treatable diagnoses listed in my screening test.

QUESTION:

Dear Dr. Heller,

Very informative web site.  I have a question about BuSpar.  Is it possible that it can effect your estrogen levels?  I am presently taking Sam-e (400mg) along with 10mg of BuSpar.  I am experiencing painful breast tenderness (normally only usually happens pre-menstruation).  Any information would be helpful.

Thanks.

 

ANSWER:

There’s nothing in the package insert (or PDR) about it, and I’ve never encountered a patient complaining of breast tenderness with BuSpar. There are concerns about Sam-e, particularly with drug interactions.  That would be the more likely explanation, along with some other GYN problem unrelated to either medication.

What If BuSpar Makes Me Worse?

QUESTION:

Dear Dr. Heller,

After taking Celexa for depression, anxiety, racing thoughts, dysphoria, and rejection sensitivity, it helped after just 2 weeks in reducing the severity of most of my symptoms.  My concern is after 3-4 weeks some of the side effects such as diarrhea and teeth clenching have not gone away.  Additionally, I found Celexa was making me nearly hypomanic.

Given my long history of cognitive GAD, OCPD, and Fractured Enjoyment symptoms, I figured BuSpar taken with Celexa would help reduce my side effects and stop the hypomania.  I began with a 10mg daily dose of BuSpar taken in two parts, morning and night.  After just a day my hypomanic symptoms were completely gone.  And so was much of the elevated mood I got from the Celexa.  Additionally, after increasing the dosage to 30mg on the second week, the BuSpar made me feel very angry and my teeth clenching got worse.  I suspect reducing the dosage of BuSpar, and slowly increasing over a longer period of time may be in order.  Would you agree with this?

Lastly, your site mentions Celexa can cause diarrhea in those with Cognitive GAD, and you generally recommend Prozac over Celexa.  Given this information, I would like to stop the Celexa and begin taking Prozac.  If I do that, should I continue taking the BuSpar?  Or should I stop it and first determine whether Prozac increases my anxiety or also causes hypomanic symptoms?

 

ANSWER:

First BuSpar has nothing to do with hypomania.  If you have bipolar you’ll need a mood stabilizer like Tegretol, Depakote, Neurontin or lithium.  If you have the BPD, Tegretol is the best option. BuSpar lowers the genetically elevated 5HT1 receptor that causes persistent worry, and is aggravated by SSRI’s.  Those with post traumatic stress disorder appear to have an elevated 5HT-2 receptor that can be worsened by BuSpar and also need Remeron, usually only for a few months. I much prefer Prozac to Celexa, although Celexa is usually my second choice.  Both Celexa and Prozac will worsen the GAD. Going up slowly with BuSpar can sometimes resolve these problems. The most important thing you can do is get all your medically treatable diagnoses made and treated comprehensively.  My screening test may be of help.

 

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QUESTION:

Hello!

I have a few questions. First let me give you some background information. I have a 26 year old brother. I have some concerns about him. From a very young age (7-8) he started being cruel. He used to beat me up (I am 2 ½ years older). He left home when he was 16. He always seems to think that everyone has everything given to them. Just before he moved out, he told a number of people that my parents beat him all the time (they do not, nor ever have). He recently started to tell people that my husband beats me. Again, this is completely untrue. He will tell us that he has a promotion at work, and then have to ask for money.

I am at my wits end, and never know when he is going to either threaten to hurt someone, or start an untrue rumor which may harm the person. My question is: how can I help my brother to understand that he has a problem. I have spoken to him about his drug use, and he has stopped using drugs. I know that he did not stop because of me, but at least he is not still taking them. This is putting even more of a strain on my family. Is there any way to help him? I would appreciate any help.

 

ANSWER:

If he has a severe character disorder or the antisocial personality disorder there is nothing that can be done at the present time, although I’m confident some solutions will be available in the future. In the strongest terms possible I recommend he listen to Zig Ziglar’s tape series and/or consider attending one of his “Born to Win” seminars. It has been my experience that most people want to be happy, successful and honest, but they have either lost their way or are in a great deal of pain that interferes with their judgment.

There are many diagnoses, however, where lying and antisocial behaviors are sometimes the response to their neurological problems: Bipolar disorder – particularly in children can cause a pattern of profoundly antisocial behavior. This is particularly true during mania, but also as a defense after it’s over due to the intense humiliation a bipolar mania episode can bring. Attention Deficit Disorder can result in impulsive behavior and lying. Often the defense for acting or speaking without thinking is a quick reply that isn’t thought through adequately, as if it’s an instinct. Many individuals have this symptom go away with medications like Ritalin. The borderline disorder can cause lying behaviors because of fear of consequences, humiliation about behaviors, and psychosis – where the “cornered animal” response kicks in and the individual believes (remembers) things incorrectly. The psychosis is a terrible problem because the individual can’t distinguish between reality and their misinterpretation. The individual with the BPD “believes” things that aren’t true, act on them, and subsequent behaviors “prove” that he/she was right due to a “self-fulfilling prophecy.” The generalized anxiety disorder, panic disorder, phobias and other anxiety disorders can also cause lying behaviors to reduce the fear and the perceived risk of consequences. All of them can cause substance abuse – which in and of itself can cause the behaviors you described. You might consider printing up the screening test and the back cover of my new book at http://pks.947.myftpupload.com.

QUESTION:

Hi Doctor Heller,

I am Jenny… a 23 yr old crazy woman. Recently diagnosed w/BPD, I need to find out how to get help. I was diagnosed bipolar until a few months back. I just lost my job as a nurse because I feel myself slipping away. With no insurance I went to MHMR. They don’t help people w/my diagnoses. I have no money and am a single mom of a 4 yr old and 7 month old. I am ssssslippppppppping away. What are some resources I can utilize for not to much $$$$$$$. I know its a stupid question but I have never been more out of control in my life. I hope you get to read this.

Thanks,

Jenny

ANSWER:

You’ll have to do much of this work on your own. The screening test on this Website will be of enormous help, particularly depression. You seem depressed. That’s a diagnosis most primary care physicians will treat, and mental health clinics will at least treat that. Literature showing Prozac also works for the BPD is available in the BPD section on this Website. Most physicians can get you started on an antidepressant like Prozac, and often the company will help indigent people with medications. You can get more information at http://www.navicom.com/~patty/eng/33h.htm .