Category: Articles

QUESTION:

Dear Dr. Heller:

My daughters hypothalamus was damaged after debulking a tumor.  Almost three years now we’ve been battling a constant appetite.  She’s currently taking other medications, cortef, Synthroid, DDAVP and BuSpar.  Is there ANYTHING out there that she could take to suppress her appetite?  If so, please respond.

 

ANSWER:

Some medications can indeed suppress appetite including Topamax and higher doses of Remeron.  Meridia is an appetite suppressant as well, but a poor one.  I’d highly recommend doing the screening test I use for my patients to see if there are any diagnoses present that need treatment.

If nothing shows up, a visit to an academic center that specialized in appetite seems to be in order.

Do I Really Need BuSpar Or Is Luvox Alone Enough?

QUESTION:

Dr. Heller,

I find your web site fascinating.  Question: I have just started taking Luvox to help me with my social phobia, depression, and worst, my unstoppable obsessive thinking patterns.  it has been very helpful (I had tried everything else).  I was also on BuSpar 40mg a day.  My doc said I could back off from the BuSpar cause I was feeling a little too hyper.  Do you think Luvox alone is ok (so far so good) or does the BuSpar help?  I prefer not to take the BuSpar-it seems to make me edgy!  I seem to flip flop between being calmer and more agitated with it.

Thanks

 

ANSWER:

It depends upon the diagnoses.  If the generalized anxiety disorder (GAD) – particularly the cognitive component – is not present, then you don’t need BuSpar.  The GAD is a genetic trait that I often refer to as a “cave guarder.”  I explain this in the book “Biological Unhappiness.” All the SSRI’s can work for social phobia, depression and obsessive compulsive problems.  I rarely prescribe BuSpar above 15mg twice daily.  If the Luvox is working, fine.  If it isn’t a re-evaluation is needed.  The screening test I use for my patients may be helpful in this regard.

 

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QUESTION:

Dear Dr. Heller,

My son has had emotional problems most of his life. He’s 19 years old. His father is an alcoholic, and could go into a rage from time to time, but manages to hold onto a very good job. My son’s problems seem to be that he can’t get along with people and will do things to get them angry at him.

He went to live with his father for two years and during that time got into so much trouble. He started stealing from his father and then from a friend’s father and got caught. He was charged with three felonies for check forgery. When he came back to me he was so out of control. Cutting himself, stealing, lying. Doing really strange things to get back at me if I disciplined him. He couldn’t sleep. Would steal my car and drive all night long. I took him to a psychiatrist and he said he has BPD. He started him on Risperdal. Then I took him to another doctor who put him on Depakote. Now he’s on Depakote 500 mg in a.m. and 500 in p.m., 4 mg Risperdal, and 20 mg Paxil. He’s groggy most of the time and has gained about 100 pounds. It’s so sad. So the doctor suggested Neurontin instead of the Depakote to lose weight. He just started that the other day and last night he said he was feeling suicidal and felt like cutting himself again. The doctor said give it two more days and then if no better would put him back on the Depakote. But the weight gain is horrible! Does this sound like BPD? I would like to try him on your plan of Prozac and then Tegretol. Does Tegretol have the weight gain associated with it like Depakote, or is the Risperdal causing the massive weight gain?

 

ANSWER:

The BPD sounds like a likely diagnosis, although I’m highly suspicious AD(H)D may be present as well. I strongly recommend doing the screening test that I use for my patients – and for both you and the boy’s father to do the test to see what diagnoses you have in common. Genetics plays a very powerful role. Treating all the diagnoses comprehensively is crucial. I’ve never been impressed with Depakote. It just doesn’t work that well for most patients in my experience. Tegretol is generally far superior. Unlike Depakote, Tegretol doesn’t cause weight gain unless it also causes low thyroid (which can of itself cause weight gain but is easily treatable). Risperdal and Zyprexa can cause profound weight gain. I prefer to use Risperdal only during the most severe crises, suicidal spells, and during severe dysphoria (anxiety, rage, depression and despair). Neurontin can be a fair second or third choice for a mood stabilizer, but it rarely works. I also haven’t found Paxil to be as effective in treating the BPD as Prozac is, but it is a reasonable second choice. Paxil can profoundly worsen irritable bowel syndrome in some patients.

QUESTION:

Dear Dr. Heller,

I have a 13yr old daughter that has ADD, she is having a lot of trouble playing basketball although she exceeds at ball handling skills.  Does the ADD keep her from being able to perform or think during a game?

ANSWER:

No, although she’ll likely be more impulsive.  This is likely to manifest itself as shooting without thinking first and getting more fouls.  She may have a hard time remembering a coach’s instructions, particularly when there is a lot of noise and stimulation around.  She’s going to be more aware of movement, which can be a big plus.  Hyperfocusing will likely help her as well.  Psychostimulants such as Ritalin may be of enormous help in this regard.  If these medications are not acceptable to her league, alternatives such as Wellbutrin and Effexor may be a good choice.  I’d also recommend looking for other diagnoses, particularly the BPD and generalized anxiety disorder.  Fear and anger can cause behaviors that wouldn’t be chosen in a different time and place.

QUESTION:

Dear Dr. Heller,

Thanks for your time. I suspect I may have BPD and have suspected for some time. I know you can’t make an official diagnoses but I was wondering if you could tell me if it’s a possibility. I’m 26 years old and have very intense anger. It is mostly geared towards my husband who I lash out at and say horribly mean things to. It is black and white with him. When I get angry I almost always hit my head or bang it against the wall. I also self-mutilate, which I have been doing (along with hitting my head) for about 10 years. I’ve had terrible anger for the same amount of time and longer.

I also have an eating disorder. Mostly at night, I get extremely bored and have feelings of emptiness. But it depends. If I’m having a depressed mood, which can last for about 3 days before it goes away. If I’m depressed I feel empty anyway. But if I’m not, I still switch into rages and feel mostly empty at night. To counteract this I self-mutilate, scream and yell till I’m exhausted, or binge eat till I’m so full I can’t stand it. This is very intense for me and I have been very depressed.

On normal days, without depression, I don’t find I have mania. I just feel able to function normally. These usually last about three days also, going downhill as I get to the third day. My anger is very sudden though. I also get paranoid sometimes. Not to extremes though, or where I rule my life by it, just suspicions that I think probably aren’t true but don’t know for sure. Things like people listening in on my conversations in the house with walky talkies ( I have a baby monitor) or people knowing how awful I am, but being nice to me so they can set me up for a fall. My jealousy of my husband is extreme though and causes lots of grief.

Thank you for your time.

 

ANSWER:

Any time an individual has to deal with “intense anger” the BPD must be considered. Self-mutilation is a strong clue as well.

If you simply look at the official criteria, I think you’ll see that you fit it very well. The front cover of my first book “Life at the Border – Understanding and Recovering from the Borderline Personality Disorder” shows many of the symptoms those with the BPD have to deal with. There’s lots of information in both of my books and this Website that can be extremely useful to you. “Life at the Border” is on the recommended reading list at the National Institute of Mental Health. The front cover can be found on this Website.

The BPD is a treatable medical problem. I encourage you to find out more ASAP!