Q. I am a 43 year old female with a “long and complicated physical and psychiatric history.” I have been diagnosed with BPD, GAD (with panic attacks and agoraphobia), psychotic depression, PTSD and dissociative identity disorder. In addition I have epilepsy with partial complex seizures primarily arising from the left temporal lobe. I get two other kinds of spells and I’m awaiting results of testing for narcolepsy/cataplexy.
I’ve had a long (all of my adult years) history of insomnia, and sleep meds help but I become addicted to them. In addition I worked in a documented “sick” building which had indoor air pollution (high CO2 and CO levels), mold and neurotoxins found in the carpet and lead in the drinking water. I worked there for 11 years before this was discovered and my health fell through. Besides significant memory loss, confusion and processing problems I had GI problems (ex. an intestinal infection which lasted 8 months and did not respond to medication).
I have had very little relief from meds. 4000mg. of neurontin have helped my epileptic seizures but have had no effect on my depression. Likewise I failed med trials of tri-cyclics, MAOIs, SSRIs and recently remeron. ECT treatments showed positive results after 5 treatments but I sunk fast and lower than before 2 weeks later when I hit my first significant stress. I failed to respond to all the known anti-convulsants (which were tried before the neurontin).
I have a high degree of rejection sensitivity. Also I believe I hold special powers and for instance a voice will come into my head telling me if I don’t use red ink to write a note, there will be a severe earthquake in the world. I feel compelled to follow the voice. I also feel that sometimes strangers can read my mind. I had one occurrence of hypomania about 6 months ago. The depression has been lifelong, but got unmanageable when my physical health fell through 2 years ago (seizures, GI problems).
I am particularly sensitive to meds and my worst 2 reactions were to parnate – (vivid, intense hallucinations mostly of a paranoid nature) and lithium which made me even more depressed (I was on it for 6 months.) Any comments are welcome.
A. You have certainly been through it. Assuming your diagnoses are: BPD, DID (dissociative identity disorder), panic disorder, rejection sensitivity, GAD (generalized anxiety disorder), chronic psychosis and complex partial seizures, you are actually not that hard to medicate properly – if you’ll take it! People like you tend to be very afraid of medications and even the most minimal side effects. It usually (but not always) complicates treatment.
The other personalities will only let you be the primary person when they perceive you can handle stress and are no longer at risk. Everything must be treated well and successfully for you to recover. And it can be done if you’re willing to take the medication (even putting up with side effects for a while), and commit yourself to a happy and successful life.
I actually do have a patient with virtually you identical profile – assuming what you told me was correct, although she doesn’t have paranoid hallucinations (which may simply be chronic dysphoria (anxiety, rage, depression and despair) from the BPD). The sequencing of medications is often as important as the actual medications. The psychosis and GAD must be treated first.
I don’t know you, I don’t know if the diagnoses are correct, and I’m not your physician. If I had a patient with your profile, this is an example of an approach I would use:
The antipsychotic medication Risperdal must be initiated, even if you’re temporarily oversedated – you’re clearly having psychotic experiences and your overreaction to medications must be controlled until the entire package can be completed. BuSpar is the next step. You’ll likely need 30-60 mg daily – increasing gradually and steadily. Once the anxiety is somewhat less Paxil would be my next choice. Theoretically Prozac and Zoloft work as well for panic disorder, but in my experience they really don’t work that well – particularly in borderlines. 40mg daily of Paxil takes approximately 10 weeks to eliminate the panic attacks. After a week on Paxil I would add Prozac for the rejection sensitivity (20-40mg daily). One week later Tegretol can be started, and will likely be perceived as an absolute miracle. The goal of Tegretol would be the upper limits of normal. This process takes approximately 3 months and requires blood levels and dose adjustments. Side effects can be a problem, but they’re usually manageable.
I would strongly advise avoiding addicting drugs, MAO inhibitors like Parnate, and lithium. You might want to get your B12 level checked, many of the symptoms you’re blaming on the building may be due to a vitamin deficiency which is commonly found in the BPD.