Biological Unhappiness

Is Klonidine A Good Choice For Stress?

Is Klonidine A Good Choice For Stress?

QUESTION:

Dear Dr. Heller,

My doctor just gave me Klonidine for stress. Is this a good choice?

ANSWER:

I assume you mean “Klonopin” and not Clonidine. Clonidine is a high blood pressure medication that is sometimes used in children for behavior problems. Klonopin (clonazepam) is a long acting benzodiazepine medication (like Valium) that is commonly used for panic and severe anxiety. Like the other medications in the class they are potentially addicting and abusable, and they can impair you with driving or using machinery (even if you perceive they aren’t). I usually recommend for my patients that they do my screening test to determine what other diagnoses are present that could be treated to stop the anxiety. Thanks Debbie

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2000 July Questions

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Is Celexa Going To Hurt My Boyfriend?

QUESTION:

Dear Dr. Heller,

Hi, I have a couple questions about the drug Celexa. My boyfriend is only 15 and he has been taking it since January. His doctor recently took him off of it. We watched a special on 20/20 about anti-depressant drugs and the side effects that have very negative effects on people. He is now worried about any side effects that may show up once he stopped taking the pill. If you could give me a list of them, that would be very much appreciated. Also, anymore information you have about this drug and mainly the effects of not taking it anymore.

Thank you

ANSWER:

There may be long term risks for all medications. No one knows. This includes birth control pills, Tylenol, antidepressants, antibiotics, etc. We can only go with what we do know for sure and make value judgements. Most people who take Celexa and other SSRI’s have no long term problems. Not only is it usually the best, the Prozac has been around the longest in the US and is the most studied medication. It is now considered safe in pregnancy. Celexa doesn’t have the long term US safety data yet, and a withdrawal syndrome may develop – which interestingly is treated with Prozac. The side effects of untreated depression are devastating including premature heart disease, cancer, strokes, and particularly substance abuse. We know for a fact that alcohol, cigarettes or other forms of nicotine, cocaine, intravenous drugs and marijuana are damaging long term. Evaluating risks is a lot like choosing to drive a car – there are risks, but do the benefits outweigh the risks. If the individual will self-medicate with alcohol or the other drugs mentioned above, Celexa clearly is safer. I often tell my patients that if it’s more dangerous to drive to the drug store to get the medicine than it is to take the medicine, that to me the medicine is safe.

Is BuSpar Really Safe?

Is BuSpar Really Safe?

QUESTION:

Dr. Heller,

My cybernickname is Perkins. I found your web site about BPD very inspiring! It gave me some of my feelings of hope back! It is sooo refreshing to see positive literature about BPD. There are sooo few psychiatrists who think even a little bit positive about BPD. There is just too much prejudice against those who have it out there. I’ve heard sooo much negativity about BPD from even psychiatrists and social workers who should know better! Lots of them refuse to work with people who have BPD!! I should know..I found out the hard way.

Most therapists freak out when I tell them I have *traits* of it, but they calm down when I tell them that I do not meet criterion #5. My former psychiatrist told me about three years ago that I have *TRAITS* of this disorder, but that it’s not a diagnosis because it’s not full-blown. She added that it’s healthier to have just traits of it as opposed to a full-blown syndrome or Dx. I just needed to ask you about BuSpar…right now, I am taking 150 mg of Zoloft and half a tablet of Klonopin every other day. I take Inderal PRN. http://pks.947.myftpupload.com/AskDoc/doc699.htm This site says “BuSpar is one of the safest medications available.” Do you still feel that way? Doesn’t medication affect everyone differently? What’s safe for one person may not be safe for another person?

BuSpar was one of the first medications that I tried out 3 years ago.(I was on Paxil and BuSpar at the same time).I had a VERY bad reaction to BuSpar during July 1997 so I asked my then-psychiatrist to take me off it…when she did, the bad reaction went away totally!! I am very sensitive to most psychotropics. Anyway, this reaction took the form of jerky movements in my arms, butt, and legs..only when I was in bed. That was the first and last time in my entire life that I had ever experienced those kinds of jerky movements!! It was a scary experience! I normally do NOT experience any kind of jerky movements or seizures. My then doctor told me it was a form of Huntington’s Chorea??? Jack M. Gorman, M.D. also wrote in a book called “The Essential Guide to Psychiatric Drugs” on pages 144-145 that theoretically, BuSpar MIGHT cause Tardive Dyskinesia if taken for many years. He goes on to say “In fact, this has not occurred to patients who have taken it although the drug has been on the market only about three years.” The copyright info says this book was published in 1990 and 1995. I am not sure what year BuSpar got on the market. Just wanted to point that out. I sure hope you don’t mind. Again, thanks for writing a BPD web site that is full of hope and realistic optimism. It made me feel much better.:-)

Cordially, Perkins

ANSWER:

First thank you for the kind words. The problem with BuSpar is that it often makes patients worse before they feel better. Those side effects are usually the same as those you would get from being very scared. There are 15 different serotonin receptors, but elevations in #’s 1 and 2 (5 HT-1 and 5HT-2) are the problem here. BuSpar will block #1 after initially raising it. This is a genetic worry gene. The 5HT-2 is more associated in my experience with post traumatic stress disorder. At this time BuSpar is still considered one of the safest medications on the market – considerably safer than not taking it if needed since anxiety causes profound effects on the body. I had a patient take 250mg of them, and the poison control center told us to ignore it! There’s no significant information that I’m aware of regarding tardive dyskinesia and BuSpar. What I’ll often do for individuals like yourself is start with low BuSpar doses (perhaps as low as 2.5mg to start). If these doses are a problem I’ll usually need to add Remeron or Serzone to block the 5 HT-2 receptor site. Then the BuSpar and Prozac can be taken without side effects. Never, ever minimize the effects inappropriate anxiety can have on someone.

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2000 June Questions

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Is Breast-Feeding Safe When Taking Zoloft?

QUESTION:

Dear Dr. Heller,

My Sister-in-law is concerned that: 1. She may have to stop breast feeding her daughter after taking Zoloft. 2. She can’t take another drug (I don’t know the name but has a similar effect as Valium) which was prescribed in concert with a Prozac or a Zoloft prescription which accelerated her recovery from previous crises events and still breast feed. (The second drug was Xanax) She appears to me to be at a crisis stage where in her own words “she can’t take anymore”. As you can imagine, the family reaction is mixed from “Get over it” to “If I could just be there to hold her”. My Mother-in-law has similar problems and is on medication and I’m sure my wife at times has concerns of her own. We’ve counseled her to talk to her pediatrician but in any case she should understand that her well being is more important to her daughter than the breast feeding.

ANSWER:

Like all other medical problems, it comes down to risks against the benefits. There is no significant data regarding breast feeding when taking Zoloft. Zoloft is used for children 6 and older. Xanax has the high possibility of causing addiction in the baby as well as the mother. The consequences of depression and raging while breast feeding – or not breast feeding at all – also need to be taken into consideration. Maternal/infant bonding is a very, very important time. Prozac is considered safe during pregnancy, so it might be a reasonable alternative during breast feeding. In my experience, Prozac is more effective than Zoloft for most people as well.

Instruction sheet for both BPD dysphoria and mania/hypomania

DR. HELLER’S INSTRUCTION SHEET FOR BOTH BPD DYSPHORIA AND MANIA/HYPOMANIA

Ask The Doctor Dr. Leland Heller Biological Unhappiness

DR. HELLER’S INSTRUCTION SHEET FOR BOTH BPD DYSPHORIA AND MANIA/HYPOMANIA

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I’m Terrified, Do I Have To Take Medication?

QUESTION:

Dear Dr. Heller,

I have BPD and they want to put me on an antidepressant and anti-anxiety drug. Is this standard treatment?. I don’t want to take medication. I’ve had very bad experiences with them in the past. Please reply, I’m terrified Have A Nice Day!

ANSWER:

I can’t comment on whether any specific medication being prescribed for you will work or not, but I can tell you medication is standard treatment and your life will likely be full of needless misery unless you take medication. The medical treatment of the BPD sheet I use for my patients along with the dysphoria instruction sheet are available on my Website. There is a great deal of information available for you in this regard about medications. It’s often not just the medication, but how they interact with other diagnoses – especially the GAD and PTSD, the sequencing, and dosing. I highly encourage you to review the screening test I use for my patients, and the books I’ve written may give you the information you are looking for to make a wise decision.