Category: Ask the Doctor

Is Serzone Effective For The BPD?

    Is Serzone Effective For The BPD?

    QUESTION:

    Dear Dr. Heller,

    My wife has been on Prozac for many years and has visited several therapists.   About two months ago our family Physician changed her from Prozac to Serzone.  She recently found a therapist familiar with BPD and diagnosed her as such.  The Serzone did not seem to be working so our family physician referred her to a psychiatrist.  He increased the dosage of Serzone.  It has  not seemed to help.  I have reviewed many websites and read books, and it  does not appear Serzone is an effective drug.  What are your thoughts on this, and if it is not effective what information is available to convince her psychiatrist to try something else.  Thanks.

     

    ANSWER:

    Like you, I have not found Serzone to be that effective a medication and I rarely prescribe it.  I have never found it of use for the BPD.  In the BPD section of my Website are many literature articles about the BPD and it’s treatment – particularly Prozac and Tegretol.  This information is a decade or more old and is still the best combination in my experience.  Making all the diagnoses using the screening test may be of enormous use as well.

Separator (Biological Unhappiness)

 

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Is Prozac Addicting?

QUESTION:

Dear Dr. Heller,

Good morning.  I’ve been on this medication for over 10 years (Prozac).  Is this drug addicting?  I would like to get off of it, but I tried twice and it didn’t work.

ANSWER:

Prozac is not an addicting medication.  All the medications in the SSRI class can have withdrawal symptoms, although Prozac has the best profile in this regard.  In fact it’s often recommended that patients temporarily switch to Prozac when discontinuing the other drugs in the SSRI class (Zoloft, Paxil, Luvox, Celexa). What could easily be happening is that you simply need to keep taking Prozac, and that the symptoms you had prior to taking the Prozac have returned.  This is particularly true if unhappiness or the BPD were a problem before the Prozac was started.  Approximately 40% of depressed individuals only get depressed once.  The rest need additional treatment in their lifetime, many permanently.

Is My Medication Hurting The Liver?

QUESTION:

Dear Dr. Heller,

I am under a physicians care and receive 25mg.  Tenormin daily (blood pressure) and 1mg Xanax up to 4X/day if needed.  I have had extreme success with this combination as I tend to have a somewhat explosive temper which is greatly relieved when I take this medicine (my family thinks so too!).  I was also diagnosed with HEP C in 1992.  I saw a liver specialist and treatment to me was unacceptable.  I know the cure is coming soon( I have bio-tech friend in the business).  My question is: What medication is least harmful to my liver?  My ongoing research shows Xanax metabolizes very quickly, thus less exposure to liver will cause less damage?  I tried Paxil and Zoloft.  Prozac is out of the question (sexual dysfunction big time, mood swings, on all those drugs).  Please respond ASAP as I am to see my Doctor on 05-22-00.  Buy the way, I’m a 48 y/o self-employed construction contractor and am in good physical condition – except for the HepC fatigue episodes I experience on occasion, and I consume no alcohol.  —John

ANSWER:

No, neither Xanax nor Tenormin will injure your liver.  The problem is that your body is slower to metabolize the Xanax – meaning you have progressively higher blood levels as time goes on. I’d highly recommend you look at the screening test I use for my patients – it may explain what’s happening to you with these other medications.

Is There Hope For This Abusive Mom With BPD?

QUESTION:

Dear Dr. Heller,

First I am giving you only one side the story, knowing that…My wife is a child abuser and undergoing a court mandated Psychological Exam (in 1 of 2 court proceedings that she has been accused of Child abuse in).  She has been abusive to children even under supervised visit situations taking them off away from the supervisors and mentally tormenting them (they are in therapy now, disclosing horrible events from the past, both 6yrs old.)

My wife’s past is atrocious, filled with so much junk that you feel very sorry for her (I mean bad).  But currently we have an infant together and I fear for his safety.  What kind of future may this hold.  She WILL NOT get help, she lies almost compulsively, Dysphoria, gaslight, etc.  She is a 9 of 9 in the DSM-IV with many extreme case examples, and other PD’s also.

I have been coordinating with many professionals and I am looking for as many resources as possible to help the infant now because of my mistake (the other boys are from a previous marriage of hers and a non-marital pregnancy while she was exotic dancing).  What dangers does a 9/9 BPD person pose on an infant?  According to the boys counselor she has deeply damaged the boys psychologically over several years and now they suffer identity disorders, anger mis-management, on and on.  I have copied your cover, and your message to BPD’s because first she needs help, and I haven’t been able to help her, but I also could not watch her attack and beat children.  This has been very difficult.  But it seems so text book, as long as your reading a BPD or addiction text.

 

ANSWER:

Certainly some individuals with the BPD are significantly tougher to manage than others, and hers seems a prime case.  I’ve seen many “severe” borderlines go on to become stellar human beings, and those with “mild” cases become extremely abusive, manipulating, hurtful, and destructive.  It’s very hard to predict, and I’m extremely reluctant to pre-judge. Fitting 9/9 criteria doesn’t suggest to me that someone is a higher abuser risk than others.  There’s no direct correlation with number of criteria.  If she has been abusive in court appointed supervised visits, the courts may choose to step in and stop the visitations for a while.  Your best approach for now is likely to take care of yourself and become happy and serene.  This will do more for your own children than anything a court can do.  Focusing on your wife, her problems, and her behavior will likely make everything worse for all of you.  You’ve probably done all you can at this time.  Therapists and attorneys will likely need to guide you through the maze you and the children are now caught in.

Is It BPD Or Explosive Mood Disorder?

    Is It BPD Or Explosive Mood Disorder?

    QUESTION:

    Dear Dr. Heller,

    “Angry” is the first word I think of when describing my husband since his retirement from the military.  He can still be utterly charming but “anger” is the first word that comes to mind when I think of him.  His irrational rages are painful to live through, and along with them comes a torrent of emotional abuse that I understand is splitting and projecting.  I can’t get into his head to know whether or not he feels “empty” and he vehemently denies he is a person with BPD.  Doctor, how can one tell the difference between BPD and Explosive Mood Disorder?

     

    ANSWER:

    First the BPD doesn’t begin at retirement.  Secondly there isn’t an official “explosive mood disorder.” He’s likely depressed.  Many individuals place their identity on their jobs, and lose that identity at retirement.  He’s likely suffering from a clinical depression due to this.  Counseling and getting to work at something that makes him feel important is crucial. The screening test that I use for my patients may give you some clues to any underlying biologically treatable disorders.  The depression Newsletter I give my patients may give some additional information to him about depression.

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Is It Mono And What Can Be Done?

QUESTION:

Dear Dr. Heller,

I am 45 years old.  I was diagnosed with mono after I requested my doctor test me for it.  Until that time he told me my throat and sick feeling was from allergies…viral……nothing he could really do anything about.  Please tell me what I can do to hurry up and get better.  I am so tired of my throat hurting.  He won’t test me for strep or Epstein-Barr and has never touched my glands, spleen or liver.  Is this normal for a doctor to NOT investigate a little further?  I was slightly anemic from excess bleeding (female problems) when I started feeling badly.  I have so many questions, but I hate to waste the time writing them and asking if a real live person is not going to respond.  So, maybe you can let me know if there are experts that will reply or if I should just look for another doctor.  My doctor did tell me that he had never had a patient over 30 with mono.  Is a younger patient treated differently?  He also told me that once I was symptomatic I was no longer contagious.  What do you think?  Thank you so much for your time….especially if you are a REAL LIVE PERSON!!  (ha)

ANSWER:

It’s time for a second opinion.  Mononucleosis is an infection caused by a virus in the herpes class.  Other viruses in the class cause chicken pox, shingles, and a form of lymph gland cancer. There’s really not much that can be done for mono at this time, although some people may respond to anti-viral medications like acyclovir. A persistent symptom always needs to be investigated.  Common treatable causes include GERD (gastroesophageal reflux disease – where stomach acid goes up the esophagus and burns the throat), post nasal drip, dry nose requiring mouth breathing and a resulting dry mouth.  Many of these disorders can have only a sore throat as the symptom.  Many other problems can cause a persistent sore throat, and it should clearly be investigated. A good step now is to see another primary physician (family physician or internist) or an ENT specialist.