Category: Articles

QUESTION:

Dear Dr. Heller,

Will you tell me, is it possible to have (and recall later) hallucinations during an epileptic fit?

Thank you.

ANSWER:

Yes, particularly if the seizures are in the brain’s limbic system or “complex partial seizures”.  This is especially true for those suffering from the BPD.

QUESTION:

Dear Dr. Heller,

I got Haldol 2mgs from my psychiatrist for dissociation and dysphoria.  Now I hear from my therapist (4th year resident) that something awful can happen to me unless I take something called Cogentin with it.  I thought that only if you’re on Haldol every day could something bad happen, but he said that even for one dose I can get something called torte- (I don’t remember the rest of the word but he did a demonstration where his body was twisted and his tongue sticking out).  Now I am afraid to take Haldol because my medical Doctor did not prescribe the antidote to be taken with it.  Although I am on Wellbutrin and 10mgs of Prozac every day, I am suicidally depressed.

 

ANSWER:

Your therapist’s immaturity is showing.  It was an extremely inappropriate thing to say.  Your psychiatrist did the right thing, and clearly has your best interests at heart.  I commend your psychiatrist for giving you as needed medications to stop dissociation and dysphoria (anxiety, rage, depression and despair). Everything in life (and especially with medicine) is balancing risks against the benefits.  It’s dangerous to drive a car, but the benefits usually outweigh the risks.  When you turn on the hot water, the pipes could explode.  It’s highly unlikely, but it could happen.  You perceive the benefits as outweighing the risks. Rarely does Haldol cause a side effect called a “dystonic reaction”.  This is a temporary imbalance in dopamine in a separate part of the brain that are called the basal ganglia.  Dopamine blockers like Haldol cause a relative imbalance with another neurotransmitter called acetylcholine.  It can be blocked with a medicine like Benadryl or Cogentin.  Since it rarely happens, using Cogentin or Benadryl whenever you take the Haldol is only necessary when the individual gets a reaction at a specific dose.  This side effect is often dose related.  The dysphoria instruction sheet I use for my patients explains this. Long term daily use – particularly in the elderly – can cause a serious neuromuscular disorder called tardive dyskinesia.  The risk is small but real.  The risk of suicide or self-destruction from not treating dissociation and dysphoria (anxiety, rage, depression and despair) are also very real.  What I do with my patients is add Tegretol when they need lots of Haldol.  Here is the medication sheet I give to my patients.

Is The Goal To Achieve Balance?

QUESTION:

Dear Dr. Heller,

I was wondering if the medication is just to help with “balance”.  Really, there is no “cure” for borderline…..you have to just learn how to live with it and the goal is to achieve “balance”.  Is that correct?  If you can find “balance” without the meds then is that what the ultimate goal is?

 

ANSWER:

No.  The goal is not to achieve “balance”.  My goals are very high when treating the BPD.  The symptoms I want to see gone with medication are: a)    Inappropriate mood swings b)    Chronic anger c)    Emptiness and boredom d)    Emotional pain – feeling like your best friend died e)    Chronic dysphoria (anxiety, rage, depression and despair) and dissociation f)     Control of dysphoria (anxiety, rage, depression and despair) and other stress induced symptoms. I’ve never encountered anyone with the BPD who was able to achieve these goals without medication.

 

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QUESTION:

Dear Dr. Heller:

I am presently taking Prozac 60 mg with good effect.  On occasion I suffer from severe “dysphoria” which I treat with Zyprexa PRN.  Taking Zyprexa only as needed is helpful and kicks a dysphoric spell somewhat quickly. 

I see in your other articles that you recommend Haldol on a PRN basis.  Is there a difference?  Is Haldol superior to Zyprexa in BPD?  I, myself am not worried about the weight gain of Zyprexa.  Aside from that side-effect, is there any major differences with these two drugs?  I know Haldol is a typical and Zyprexa is an atypical antipsychotic.  Also, how about Risperdal?  Is this comparable or better in any measures?

ANSWER:

First I want to say how thrilled I am that you’re taking an antipsychotic medication on an as needed or “prn” basis.  It’s a crucial part of successfully treating the BPD.

Zyprexa can work that way, although it usually takes 60-180 minutes to work.  The weight gain is a huge problem, as is expense.  Many people complain they don’t “have any feelings” while taking it, and it tends to make patients very groggy.

Risperdal is great on an as needed basis.  When an SSRI (particularly Prozac) is in the system and a severe crisis develops, Risperdal – usually at 3mg – has no equal in this regard.  Side effects are a problem at this dose and I warn patients they may be groggy and non-functional for a day or more.  Interestingly Risperdal is rarely effective on an as-needed basis if taken daily.

Haldol is a typical antipsychotic, which means cumulative dose is more likely to cause a problem with tardive dyskinesia than Risperdal or Zyprexa (weight gain from these two medications can cause diabetes and resultant heart disease, arthritis, high blood pressure and stroke – these medical complications need to be taken into account.)  Haldol in low doses has been shown in the literature to work on an as needed basis for transient (or temporary) psychosis.  Side effects are rarely a problem and the individual is usually able to return to work or family life in 5-10 minutes with the dysphoria (anxiety, rage, depression and despair) gone and without impairment.

Things Are Getting Worse.  Can You Help?

QUESTION:

Dr. Heller,

I wrote to you not long ago, but I believe that I forgot to give you my email address.  I am writing you again only things have gotten much worse since.  Everything just got to unbearable and I attempted twice to take my life and was unsuccessful.  Once by taking a handful of Ativan, and two days later cutting my wrist.  I am on Wellbutrin and Depakote and I am not noticing any difference.  I was discharged from the hospital yesterday, with the understanding that I would be going to a 28 day treatment facility for drug abuse, but some how the paperwork got screwed up and now they have me on a 7 to 8 wk.  waiting list to get in.

Everybody that loves me in my life slowly diminishing from my life due to depression to my fits of rage.  I feel sometimes that this course in my life is unstoppable.  I have been dual diagnosed Bipolar and substance abuse but I feel that my problem runs much deeper.  My girlfriend out of profound concern for me has delved into the psych.  world and found your Website.  From reading testimonials and facts she and I feel that there is a great possibility that I could be suffering from borderline personality dis.  as well.

PLEASE HELP!

 

ANSWER:

I would virtually guarantee you that you have the BPD.  Whether you have bipolar or other diagnoses also remains to be seen.  My screening test may be useful to you in this regard.

It’s important to realize that your condition is potentially fatal.  In my experience your medical regimen is highly unlikely to help and may worsen your condition.  The medications I use are explained at length in my Website.

I encourage you to read the Website at length and my books since they will give you the hope you so desperately need.  You can do great.

I have many patients from all over the country (31 states) and abroad (5 countries).  If it’s worth it to you, I’d be happy to see you.  Please look at the section on seeing me as a patient if you wish to do so.

 

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