Ask the Doctor – Page 4 – Biological Unhappiness

Is BuSpar Really Safe?

Is BuSpar Really Safe?

QUESTION:

Dr. Heller,

My cybernickname is Perkins. I found your web site about BPD very inspiring! It gave me some of my feelings of hope back! It is sooo refreshing to see positive literature about BPD. There are sooo few psychiatrists who think even a little bit positive about BPD. There is just too much prejudice against those who have it out there. I’ve heard sooo much negativity about BPD from even psychiatrists and social workers who should know better! Lots of them refuse to work with people who have BPD!! I should know..I found out the hard way.

Most therapists freak out when I tell them I have *traits* of it, but they calm down when I tell them that I do not meet criterion #5. My former psychiatrist told me about three years ago that I have *TRAITS* of this disorder, but that it’s not a diagnosis because it’s not full-blown. She added that it’s healthier to have just traits of it as opposed to a full-blown syndrome or Dx. I just needed to ask you about BuSpar…right now, I am taking 150 mg of Zoloft and half a tablet of Klonopin every other day. I take Inderal PRN. http://pks.947.myftpupload.com/AskDoc/doc699.htm This site says “BuSpar is one of the safest medications available.” Do you still feel that way? Doesn’t medication affect everyone differently? What’s safe for one person may not be safe for another person?

BuSpar was one of the first medications that I tried out 3 years ago.(I was on Paxil and BuSpar at the same time).I had a VERY bad reaction to BuSpar during July 1997 so I asked my then-psychiatrist to take me off it…when she did, the bad reaction went away totally!! I am very sensitive to most psychotropics. Anyway, this reaction took the form of jerky movements in my arms, butt, and legs..only when I was in bed. That was the first and last time in my entire life that I had ever experienced those kinds of jerky movements!! It was a scary experience! I normally do NOT experience any kind of jerky movements or seizures. My then doctor told me it was a form of Huntington’s Chorea??? Jack M. Gorman, M.D. also wrote in a book called “The Essential Guide to Psychiatric Drugs” on pages 144-145 that theoretically, BuSpar MIGHT cause Tardive Dyskinesia if taken for many years. He goes on to say “In fact, this has not occurred to patients who have taken it although the drug has been on the market only about three years.” The copyright info says this book was published in 1990 and 1995. I am not sure what year BuSpar got on the market. Just wanted to point that out. I sure hope you don’t mind. Again, thanks for writing a BPD web site that is full of hope and realistic optimism. It made me feel much better.:-)

Cordially, Perkins

ANSWER:

First thank you for the kind words. The problem with BuSpar is that it often makes patients worse before they feel better. Those side effects are usually the same as those you would get from being very scared. There are 15 different serotonin receptors, but elevations in #’s 1 and 2 (5 HT-1 and 5HT-2) are the problem here. BuSpar will block #1 after initially raising it. This is a genetic worry gene. The 5HT-2 is more associated in my experience with post traumatic stress disorder. At this time BuSpar is still considered one of the safest medications on the market – considerably safer than not taking it if needed since anxiety causes profound effects on the body. I had a patient take 250mg of them, and the poison control center told us to ignore it! There’s no significant information that I’m aware of regarding tardive dyskinesia and BuSpar. What I’ll often do for individuals like yourself is start with low BuSpar doses (perhaps as low as 2.5mg to start). If these doses are a problem I’ll usually need to add Remeron or Serzone to block the 5 HT-2 receptor site. Then the BuSpar and Prozac can be taken without side effects. Never, ever minimize the effects inappropriate anxiety can have on someone.

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Is Breast-Feeding Safe When Taking Zoloft?

QUESTION:

Dear Dr. Heller,

My Sister-in-law is concerned that: 1. She may have to stop breast feeding her daughter after taking Zoloft. 2. She can’t take another drug (I don’t know the name but has a similar effect as Valium) which was prescribed in concert with a Prozac or a Zoloft prescription which accelerated her recovery from previous crises events and still breast feed. (The second drug was Xanax) She appears to me to be at a crisis stage where in her own words “she can’t take anymore”. As you can imagine, the family reaction is mixed from “Get over it” to “If I could just be there to hold her”. My Mother-in-law has similar problems and is on medication and I’m sure my wife at times has concerns of her own. We’ve counseled her to talk to her pediatrician but in any case she should understand that her well being is more important to her daughter than the breast feeding.

ANSWER:

Like all other medical problems, it comes down to risks against the benefits. There is no significant data regarding breast feeding when taking Zoloft. Zoloft is used for children 6 and older. Xanax has the high possibility of causing addiction in the baby as well as the mother. The consequences of depression and raging while breast feeding – or not breast feeding at all – also need to be taken into consideration. Maternal/infant bonding is a very, very important time. Prozac is considered safe during pregnancy, so it might be a reasonable alternative during breast feeding. In my experience, Prozac is more effective than Zoloft for most people as well.

I’m Terrified, Do I Have To Take Medication?

QUESTION:

Dear Dr. Heller,

I have BPD and they want to put me on an antidepressant and anti-anxiety drug. Is this standard treatment?. I don’t want to take medication. I’ve had very bad experiences with them in the past. Please reply, I’m terrified Have A Nice Day!

ANSWER:

I can’t comment on whether any specific medication being prescribed for you will work or not, but I can tell you medication is standard treatment and your life will likely be full of needless misery unless you take medication. The medical treatment of the BPD sheet I use for my patients along with the dysphoria instruction sheet are available on my Website. There is a great deal of information available for you in this regard about medications. It’s often not just the medication, but how they interact with other diagnoses – especially the GAD and PTSD, the sequencing, and dosing. I highly encourage you to review the screening test I use for my patients, and the books I’ve written may give you the information you are looking for to make a wise decision.

Can I Have BPD And Fractured Enjoyment?

QUESTION:

Dr. Heller,

I would like to know more about ‘fractured enjoyment’. Can one suffer from BPD as well as fractured enjoyment? Besides that, can these two be cured without the use of medicine? Am I over-paranoid if I suspect that I have BPD? I would appreciate it if you can answer my queries, especially the one on ‘fractured enjoyment’.

Thank you very much

ANSWER:

What I refer to as “fractured enjoyment” used to be called the depressed personality disorder. It is profoundly genetic and responds quickly to Prozac. You absolutely can have both the BPD and the fractured enjoyment diagnosis, and they both respond well to safe medication. It’s extremely unusual for an individual to do well without medication when those diagnoses are present.

Why Won’t My Therapist Listen?

QUESTION:

Dear Dr. Heller,

I am new to the idea that I have BPD. But thanks to writings from you and many others on sites like Mental Health Sanctuary and other places I now have hope that I’m not just a crazy loser. Other people share my struggle. Other people have felt the same wild impulses and loopy ideas that have destroyed my life over and over. The fact that others have recovered gave me hope I had forgotten I had lost.

Recently, after a year of functioning, holding a job and paying bills, I crashed. I lost it on a customer at work and got fired. I then saw an HBO special on depression with Mike Wallace, which made me realize I was putting out symptoms all over the place. I only have the local county (Brevard–only about 90 minutes from Okeechobee!) facility called Circles of Care. As far as free goes, it is excellent. I made an outpatient appointment (they still remembered me) and by the time it came I had visited several sites online and found I fit the criteria for BPD. People on Mixed Nuts (www.mixednuts.net) and The Healing Path (www.geocities.com/ubester) gave me encouragement and information that led me to believe I didn’t have to keep repeating the same cycle of striving and disappointment over and over again. It was like I had a new way of looking at life.

The therapist I met was very disappointing. She was competent and friendly, but reacted badly when I brought up BPD. Prepared for this, I had a floppy disk with links and text on it but she shied away from it. I probably came on too strong. We discussed it for a few minutes, she was like “Why do you want to be THAT?” and I explained that it wasn’t that I wanted to be like this, but that it was reality and if I had this it would explain why I had failed at treatment so many times. She seemed interested in having me bring printouts of the info, but chose to retain the old diagnosis of bipolar with schizoaffective tendencies that the last therapist had tagged me with (funny, I have never had a mania or a hallucination, and I know when my feelings and perceptions are out of whack–but I have several characteristic BPD traits). She did prescribe the Neurontin and Prozac I had read work well for BPD. I feel much better now.

Question. How can I persuade her to spend the time and effort to learn what you research pioneers have found out about BPD and effective ways to treat it? I realize it will be hard to break through the stigma and misconceptions surrounding BPD and harder still for others (bureaucrats) to become educated and devote scarce resources to it.

I almost feel like if the medication works and I can keep getting it there, I’ll be fortunate. I gather the dialectical behavior therapy is long, involved, and time consuming. I can’t see it happening on a fifteen minute appointment every two weeks basis, even though I’ll try. I have missing years, and have long suspected some traumatic events in early childhood, like other BPD’s report, and don’t think dialectical behavior therapy the proper forum for deep digging.

Suggestions?

ANSWER:

I wish I knew! I’ve been fighting this battle for 12 years.

The problem is old beliefs, and the incredible slowness of the medical profession – including therapists – to respond to the information. Most medical information on the BPD is 7-14 years old.

You’re on target questioning the bipolar diagnosis if you’ve never been manic or hypomanic.

You might want to print up a few key studies to show her, or you might need to ask for another therapist.

I’m A Student On Paxil, Can I Drink Or Use Marijuana?

QUESTION:

Dear Dr. Heller,

Hello, I am in a bit of a situation and I was wondering if you would be able to give me some advice? I just started taking Paxil, I am 16 years old and as being a teenager it is quite difficult to avoid alcohol. But I actually do generally. I am not a big drinker, but with the summer coming I had intended to drink a little bit (once in a while and only one or two light drinks). I am also going to France to do my OAC English, and A big part of the life there is drinking, and I know the students are permitted to drink, I intended to have a glass or so of wine every so often, but I would really like to know if this would be ok? As well what are the effects of drugs and Paxil (i.e. marijuana, S/P?)

ANSWER:

The Paxil won’t be as effective. If you’re depressed or needing Paxil for some other reason – particularly at age 16 – you shouldn’t be taking additional drugs like alcohol and marijuana. They could trigger rage, worsening depression, or psychosis (losing touch with reality). If your self-esteem isn’t strong enough to say “no” – you probably should not go on this trip. It’s a potential disaster for you, and something from which you may never recover.