QUESTION:
Hello,
I have several questions: I am suffering from both ADD and BPD, and whether the BPD came as a result of the untreated ADD is not known. There definitely is a genetic predisposition considering my parents. As a child I experienced a lot of trauma due to my impulsive & disruptive behavior, and also lost my parents at an early age. Emotional training was definitely lacking. I am now 27 and trying to get my life in order. I am very determined, as my inner life is complete hell. . I have recently started taking Prozac, and am scouting for a specialist in BPD/ADD to discuss medical and psychological treatment. Before starting Prozac I was on BuSpar for anxiety (for 8 weeks). The BuSpar was stopped now. Can BuSpar be taken with Prozac? What about one of BuSpar’s side-effects – nightmares? At the moment I am suffering from disturbing dreamscapes, something which started 4 months ago when I moved countries. It seems that my whole past and life issue that I have never been aware of or dealt with are coming up with an incredible force. You advise Tegretol at night. What dosage? will it makes me drowsy the next day? Do the dreamscapes eventually subside and I can stop taking Tegretol, or is Tegretol merely a prevention? As for the trouble with ADD: I have had considerable success with combining Piracetam with Choline (1800mg/500mg three times a day) to help with concentration, though this does not calm me. Would this be safe to take with Prozac? Also, I have tried taking Ritalin before I took Prozac, found the concentration and calming effect very beneficial, but the up/downs were too drastic and I stopped. Apparently combining Prozac with Ritalin has been successful in a lot of patients, but how will this affect the BPD? I am especially concerned about the dopamine issue, as this seems to be related to the minipsychosis one experiences. I can’t seem to figure out though whether it is a lack of dopamine or an increase of dopamine that cause psychosis and severe dysphoria. Getting up in the mornings is a painful experience, but I seem to be able to face the world a bit more and have less disruptive thought patterns after a strong cup of coffee…
Thank you for your time.
ANSWER:
1) BuSpar can absolutely be taken with Prozac, although some patients need to take BuSpar for a while first before they can take Prozac or they may experience severe temporary anxiety from the Prozac.
2) I’ve never encountered anyone getting nightmares just from BuSpar, although clearly those with a severe GAD (generalized anxiety disorder) problem will get increased anxiety in the early stages of taking BuSpar. This can worsen anxiety related dreams. This is one of the few situations that benzodiazepines are indicated, particularly temporarily to stop those nightmares.
3) If the individual has the BPD, Tegretol at night after being on Prozac for a week is often very effective without causing morning grogginess. Sometimes individuals need to take the medication early in the evening, or at a lower dose, to prevent grogginess.
4) Sometimes the nightmares end, sometimes they continue, sometimes they worsen. It’s hard to predict. Retraining the brain makes a huge difference. By lowering the perception of stress, the individual has less of a stress induced dysphoria and/or nightmares. It’s both a treatment and prevention in the right individual.
5) I don’t know about Piracatem. If it’s a benzodiazepine like Valium, there is no problem taking it with Prozac. Choline is fine, and I take it myself because of literature that it may prevent age related memory loss. I don’t know of any significant short term benefits. Prozac can safely be taken with virtually every medication.
6) The comorbidities are crucial. One small study on bulimics with BPD showed they did better with Ritalin. I don’t believe Ritalin should be used to treat the BPD. It has a miraculous effect on borderlines who also have comorbid ADD. Since borderlines can’t trust their feelings, they need to depend on their thinking abilities. With ADD, they lose the ability to think before acting or speaking. This impulsivity gets borderlines into trouble. Ritalin can trigger BPD dysphoria in those who have the generalized anxiety disorder untreated.
7) It’s not clearly understood yet whether it’s a dopamine increase or increased sensitivity to dopamine that causes the problem, but it’s not a deficiency state. Additionally, I don’t believe that it’s a neurotransmitter problem, but a brain process that’s abnormal. Dopamine is responsible for many, many things including motor control (control of the body).
8) The strong cup of coffee is likely an attempt to treat ADD. I strongly recommend you do the screening test and see what diagnoses fit you. It’s more common to have many diagnoses rather than just one. Treating them all is crucial.