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Is My Daughter On Enough Medication?

QUESTION:

Dear Dr. Heller,

I wish so much that I could have a telephone consultation with you so I could get the information I need.  If a telephone consultation is possible, please email me back to let me know when I might call.  I’m willing to compensate you for your time.  Perhaps I could conference with you and my daughter’s psychiatrist three ways; I have that option on my phone.

Bottom line, my 19-year-old daughter is just as you describe a person suffering from Borderline Personality Disorder in your book, “Biological Unhappiness.”  After reading your book, I asked her doctor to consider reading it too, which she did.  She felt you made good sense and was willing to try the meds you recommend.  But she put my daughter on only 10mg.  of Prozac to start, gradually worked her up to 30mg, and then started her on Neurontin, but only a 300mg. starting dose.

When my daughter got more depressed on these doses, she upped the Neurontin to 600mg.  There was an immediate improvement but not enough.  A few weeks later, she took over the counter sleeping pills and a few days after that, checked herself into a hospital because she was afraid of what she might do to hurt herself.  (She’s a cutter/scratcher.)  They upped her to 900mg. of the Neurontin in the hospital, but my sense is that she’s not on nearly enough Prozac, and that maybe the Neurontin would also work better if she were on more Prozac.  Maybe she needs more Neurontin as well.

Do you think all or some of these statements may be true?

Furthermore, her ADD restlessness seems worse than ever, but she claims that Ritalin and/or Adderall make her too nervous.  Do you think this effect might go away if she’s on the correct amount of Prozac and Neurontin?  I would so appreciate the opportunity to talk with you and her psychiatrist together.  Please help us.  Thank you.

ANSWER:

I’ve been extremely disappointed in Neurontin for the BPD.  If the individual with BPD also has ADHD, Neurontin can make them worse.  The Prozac/Tegretol combination is the best in my experience.  I treat cutters very aggressively because they are in so much pain.  They cut to relieve the neurological pain of dysphoria (anxiety, rage, depression and despair) like we all do to relieve the neurological sensations associated with poison ivy or insect bites – the body is further injured, but the horrible sensations feel better.

If the stimulants make her worse, she probably also has the GAD which would require BuSpar or a beta-blocker like atenolol or metoprolol.

The BPD symptoms that Prozac resolves are unprovoked mood swings, chronic anger, emptiness and boredom.  If those symptoms persist I increase the Prozac until they are gone.



 

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Can Anything Work?  I’ve Tried Everything.

QUESTION:

Dear Dr. Heller, I have been diagnosed with BPD or CPTSD and have been going to therapy steadily for 2 years.  I have used Prozac, Paxil, Remeron, Neurontin, Topamax, imipramine, Ativan, Effexor, Serzone, Celexa and even Seroquel.  DBT therapy was difficult I couldn’t continue.  EMDR gave some marginal relief with the anger component, but nothing else. It seems I am at the end of my rope and I can’t see living like this anymore, where every moderately stressful event triggers physical and emotional anxiety for days. I’m a 47 yr old male with no family or friends, (due to this disorder).  What else can be done?

ANSWER:

You haven’t been on the most important medication combination, Prozac followed a week later by Tegretol.  It’s an incredible combination.  The screening test ( http://pks.947.myftpupload.com/screen.htm) may help to find other diagnoses that also need to be treated.  Treating them all is crucial.



 

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Is It BPD Or Rapidly Cycling Bipolar?

QUESTION:

Dear Dr. Heller, What are the differences between mixed bipolar, ultra-rapid cycling bipolar and borderline?  Can a person go back and forth between different types of bipolar?  Do I have BP and BPD together?  Do I meet the criteria for any type of bipolar? I was sexually abused by father, uncle and cousin between the ages of 10 and 13.  I became promiscuous after this, and had 11 sex partners until meeting my husband at the age of 17…I had one affair after 7 years of marriage.  Does the following sound like mixed states? I’m 34 years old now. 1980 At the age of 13, I overdosed on pills of some sort – it was my 3-year-old little brother’s medicine, with rat poison – then everything went black for a split second.  I loss control of my muscles, collapsed and threw up.  My vision returned immediately.  No rages then. 1981 Removed from home at 14, group homes and foster care until age of 17.  Ran away, had sex with older men, mostly in their 20’s. 1983 I overdosed at age of 16 on Valium, and made a halfhearted attempt to cut my wrists.  No problems with rages then. 1984 I overdosed at 17 on an anti-anxiety drug (10 pills), beginning to have rages.  Broke up with boyfriend of 8 months. 1984 At age of 17, I overdosed on an over-the-counter sleep aid (about 9 pills), and had rages and anger.  I have a new boyfriend now (we have been married for 14 years). 1989 At age of 22, I overdosed on aspirin and pills that stop lactation.  My daughter was about 2 years old then.  I had anger and rages then. I tried to take something in 90.  My husband was there and made me spit it out.  I don’t remember meds.  Rages and anger. I was diagnosed as borderline in 91.  I read, “I hate You Don’t Leave Me” in the hospital, and it convinced me that there was no hope for me.  I was committed for a month, because I was thoroughly depressed and I had intense anger and rages.  I was suicidal at the time, too.  I was sent home with Tegretol.  I stopped taking it because of the side effects.  I continued to have rages and some depression almost everyday. I had a baby in 94.  I became suicidal and intensely angry again, and ask my husband to leave and take our children.  I then went to a doctor for depression and took Prozac for three months, and I wouldn’t go back for more.  The anger was improved greatly, but my depression remained, not as severe though.  I was hopeless, but not suicidal.  I haven’t felt suicidal since, just thoughts of suicide.  I don’t rage as much. My family moved back in, in 98.  Since then, I have been dealing with few and far between outbursts, and I have lots of irritability and frustrations, panicky ((lack of concentration, easily distracted with memory problems became worse over the last year or so)).  I know these are symptoms of lots of things, but do you see a pattern?  My irritability and anger have forced my family to move out about a week ago. 2001 I have visited many sites and I just get more confused.  Some say, you have to cut to be borderline, I don’t.  Some say it doesn’t matter Some say that borderline doesn’t exist, that borderline is bipolar.  Some say that borderline isn’t a biological illness, that it’s a personality disorder.  Some say that true borderline doesn’t involve depression at all. Then I come to your site and you say it is not a personality disorder etc., and that there is a certain combination of meds that work.  Prozac then Tegretol, Haldol etc. I am taking Wellbutrin 2 pills a day 150mg each am & pm doses, Seroquel 2 pills at night 50 mg each, and trileptal 2 pills a day am & pm doses 300mg each.  By the way, I feel great in just these 3 days.  I have less distractions and not as much irritability.  I know it’s early.  I still feel good though.  My daughter said yesterday, “Mom, aren’t you gonna get mad?” I said, “Honey, I don’t feel mad.” My other question is if I am a true borderline, will I get better on this combo?  I know everyone is different, but most borderlines do well on your med combos right?  So should I expect the worse?  I have only been taking the meds for a few days now, 3 to be exact.  I don’t want to go back to the suicide attempts, or rages.  I hope you can clear some of this up for me.

ANSWER:

There’s no reason an individual can’t have both.  The criteria for a mixed episode can be located at http://pks.947.myftpupload.com/MixEpisd.htm.  Fortunately the BPD with bipolar can be treated identically as those with BPD and chronic dysphoria (anxiety, rage, depression and despair) or dissociative symptoms.  It’s extremely rare for a borderline to not respond to medications. I believe the BPD is primarily an instability and epileptic phenomenon in the limbic system (in the trapped, cornered, wounded animal instinct part of the brain).  It wreaks havoc on the personality, which is generally significantly impaired.  The three parts to treat the BPD successfully are 1) control all the chronic symptoms, 2) having as needed medications for crashing, and 3) retraining the brain. While Seroquel is helpful for PTSD problems it does very little for BPD or bipolar.  I’ve never been impressed with Wellbutrin as a BPD treatment. 



 

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Can I Get Addicted To Buspar?

QUESTION:

Dear Dr. Heller,

First I want to thank you in advance for your time and dedication to something so important as getting things in perspective for many of us who can’t do it.

These are my questions:

1. I was on Prozac and I got a Panic attack, according to your test I’m possibly GAD (always worry and with anxiety, my head does not know peace).  Is it possible that there is a connection between being GAD and my panic attack with Prozac???
2. I’m a 30-year-old woman diagnosed with BPD.  I have history of ranges attacks, very heavy ones follow by euphoria and of course dysphoria.  I’ve been in therapy for three years and finally I gained enough trust to start again on medication.  After the experience with Prozac I was scared!!!!  I’m on a medication called ORAP, it helps me with my mood swings, but not much with my stress of anxiety.  Is it possible to be on Orap and maybe BuSpar at the same time????
3. – Would I get physically addicted to BuSpar?? – Is there any other medicine that I could use only in stressful situations of anxiety? – Is it better to be on a constant medicine for GAD and for how long???

Thank you very much for your help!!!!!!!!

ANSWER:

1. It’s virtually certain.  Prozac raises the serotonin 1 receptor, which will aggravate the GAD.  Increased anxiety causes dysphoria (anxiety, rage, depression and despair) in borderlines and can also cause panic.  Once you’ve successfully taken BuSpar you should be able to take Prozac without difficulty.  If BuSpar worsens your anxiety, you’ll likely temporarily need Remeron to deal with the elevated serotonin 2 receptor commonly found in those with PTSD.
2. Orap is an antipsychotic.  I generally try to keep my BPD patients off chronic antipsychotics due to the potential long-term risks.  Orap can be taken with BuSpar.  The euphoria is probably due to bipolar disorder.  Patients with both the BPD and bipolar respond very well to the combination of Prozac and Tegretol with antipsychotics as needed.
3. BuSpar is NOT ADDICTING!  Keeping the GAD under control is crucial.  Not only does it make one’s life difficult and prevents taking important medications, but the GAD places the individual at a much higher risk of cancer and other diseases.  Most patients need to take BuSpar long term.

 

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Is There Much Overlap With BPD, Asperger’s And Seizures?

QUESTION:

Dear Dr. Heller, How much overlap do you see clinically between Asperger’s, mixed seizure disorder and BPD for that matter?  Do they tend to coexist?  Could they all be part and parcel of the same underlying problem? I have often been accused of having BPD, only to note that rather than being unable to tolerate being alone, the only time I am anxiety-free is when I AM alone.  Recently I learned about Asperger’s and it fit like a glove and explains everything for the first time in my 48 hellish years of life on Earth.  I do have uncontrolled seizures. I would so appreciate a reply.

ANSWER:

Asperger’s and the BPD are totally independent conditions that do not overlap in any way.  People can have both the BPD and Asperger’s.  The key features of Asperger’s are marked social impairment involving lack of enjoyment being with others, and restricted repetitive and stereotypical behaviors.  BPD is about mood swings and anger. I believe the BPD is also a form of epilepsy, so it wouldn’t be surprising that a mixed seizure disorder and the BPD could co-exist.



 

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Why Do Medications Only Work On Some Of The Symptoms?

QUESTION:

Dear Dr. Heller, I am a 31 yr old female, diagnosed w/ BPD and depression.  For many years I have been on/off Prozac and BuSpar.  They seemed to work great but then would abruptly end after I hit the maximum dosage. I now have a new Dr.  who has prescribed Effexor.  I am currently taking 150mg a day for about 2 months now.  The Effexor works wonders on the depression.  I haven’t had a recurring episode yet, even though I suffer from a more than moderate case of PMS.  I also seem to suffer from an intense physical reaction when encountering stressful situations.  It can be described as a flight or fight feeling.  This can be very debilitating at times. My current physician does not believe in poly pharmacy.  So my question is this, is there a medication that seems to work with the BPD symptoms and also gets a handle on extreme anxiety?  I tried mentioning Xanax put he didn’t take to this idea. My physician is a family doctor.  Should I be seeing a psychiatrist instead?  I was diagnosed originally by a psychiatrist, but due to insurance reasons could no longer see her. Any help would be appreciated.

ANSWER:

I suspect the problem with your medication regimen is you don’t have anything to take when you are experiencing dysphoria (anxiety, rage, depression and despair).  I’ve been disappointed in Effexor for the BPD, although some practitioners report good results with very high doses in the 450 to 600mg per day range. I make all the diagnoses present on my screening test ( http://pks.947.myftpupload.com/screen.htm) and treat them comprehensively. There’s a lot of information in the BPD section ( http://pks.947.myftpupload.com/bpd.htm) including an article for primary care physicians ( http://pks.947.myftpupload.com/abstract.htm) and an update ( http://pks.947.myftpupload.com/update.htm).



 

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