Category: Ask the Doctor

How Do I Get Rid Of Somatic Complaints?

QUESTION:

Dear Dr. Heller,

Hello-I have read Biological Unhappiness and can identify myself and my family with the syndromes that you describe.  I myself somatize emotions and have had a very bad case of gastric esophageal reflux for 5 years.  It is very clear that it was initiated by a psychological event.  (My daughter moved in with her boyfriend.  I was very happy about this; however, the day after the move I was extremely depressed and had a severe case of GERD.  The link between the two events was obviously unconscious).  An endoscopy was negative.

My question to you is: What medications have you found most effective for somatic symptoms?  Particulary for GAD sufferers.  I see a therapist, and have a massage therapist.  Prozac made me very sick.  Diet doesn’t really have much to do with it.

Thank you.

 

ANSWER:

You need BuSpar, with Remeron if the BuSpar causes you side effects.  Somatic symptoms are very frustrating for the patient – but they are a symptom of the anxiety.  Treating all the anxiety disorders and depression is crucial.  Retraining the brain is also necessary.

 

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QUESTION:

Dear Dr. Heller,

I am female and 32 years old.  I have been diagnosed with depression of sorts.  I also find it difficult to concentrate and can’t shut my brain off from worrying about things I shouldn’t concern myself with in the first place.  I have tried Prozac it made me a nervous wreck.  On Zoloft I gained 60 pounds and didn’t find it to really help.  Effexor killed my stomach and made me nervous and could not sleep.  Celexa seemed to be working but I started to gain weight again and got scared so I went off it.  Now I am on Paxil for the past 3 weeks and it seemed to be helping (Got through Xmas really good), but the aftermath is not so good and I am starting to get down again on life, money, etc.  Any suggestions on what medication might be good for me?  Or if I can do it without any meds somehow(?).  We don’t have very good doctors in this area so I feel like I am battling this alone – maybe you can suggest a good doctor in this field someplace near me within a few hours.  I do visit So.  California often as well.

 

ANSWER:

You clearly have the generalized anxiety disorder in addition to any other problems you have.  BuSpar will not only treat it but will allow you to take medications like Zoloft and Prozac without those side effects.  Take a good look at my screening test.  I go into this phenomenon at length in “Biological Unhappiness”.

 

QUESTION:

Dear Dr. Heller,

Does the BPD’s rage and destructive behaviors manifest differently in men and women? That is, are dyslimbic men more likely to lash out physically to their partners, and women more likely to hurt themselves or their children?  Could men who are chronic abusers be those with untreated Dyslimbia and Sociopathic P.D.?

ANSWER:

In general men are more violent when out of control, but it’s not an absolute thing.  I know of many women who physically abuse their spouses and children. Many chronic abusers have the BPD – a.k.a.  Dyslimbia.  I don’t know the statistics but it’s unlikely the antisocial personality disorder would be associated with abuse.  The reason is that emotions – particularly fear – trigger BPD dysphoria (anxiety, rage, depression and despair).  Antisocials are generally not anxious and don’t respond the same way.

QUESTION:

Dear Doctor,

I have almost all the symptoms of GAD (especially my mind never shutting off) along with depression and irritable bowel syndrome.  I have read over all of your FAQs and looked at any that talked about GAD, Paxil, or Celexa.  In many you seem to say that Paxil is not good for GAD; but in one of your most recent, you recommend Paxil for it.

Is Paxil good or bad for GAD if I also start on BuSpar?  Would Celexa be a better option (along with BuSpar)?

Prozac and Effexor make me too nervous.  I just got off of Effexor.    I am just now realizing that my problems could be more from GAD than depression.  I am also seeing a counselor.  I am going to my regular doctor in a week and I need to know what you suggest.  She hasn’t done a very good job in diagnosing me, but I can’t afford a Psychiatrist.  I have a few of the symptoms of OCPD, but I don’t think I have it.  If I did, would your treatment for me be any different?

Thank you in advance for your reply.

ANSWER:

I do not recommend Paxil for the generalized anxiety disorder, particularly the cognitive component.  This is especially true if it runs in your family, making it the genetic type of GAD.

Paxil helps some patients with the somatic generalized anxiety disorder, but I suspect it’s “subclinical” panic disorder, or relief of anxiety symptoms, by relieving depression and/or social anxiety disorder.

If Prozac made you nervous, all SSRI’s will make you nervous including Paxil and Celexa.  Once you’re on the full dose of BuSpar (usually 15mg twice daily) for a week, you will likely be able to take Prozac or another SSRI without it making you too nervous.  Sometimes starting with a low dose first can make that process easier.

OCPD responds beautifully to 60-80mg of Prozac, usually 80mg daily.  Things stop feeling like they’re a “big deal.”  I go into this at length in “Biological Unhappiness.”

Why Do I Feel Worse On Ritalin, Zoloft And Buspar?

QUESTION:

Dr. Heller,

I wrote you last week with a question concerning my problems with figuring out the chemical imbalance I am having.  I would like to say that I have taken the advice you gave me in adding the BuSpar again.  I have just started it yesterday at only half the dosage of a whole pill in the morning because I take .25 Xanax at night before bed.  I think it is 7.5 mg.  of BuSpar.  Furthermore, I did not take my Zoloft today at all.  I also have cut the dosage of Ritalin to just 5 mg.  upon waking.

Today, (Christmas Day) I felt the most focused and calm I have felt in a long while.  My mind hardly raced at all either.  I told you that I have been diagnosed OCD.  Well, in reality, it is only suspicion.  I have only been officially diagnosed as ADHD, and GAD, with a heavy emphasis on the social aspect of anxiety.  Sorry if I confused things.  I just assumed I am OCD because a few doctors have said so, but I suspect that this Zoloft is making my mind race so fast and clouding it up so bad that I am obsessing a lot more.

Since the start of the Ritalin, I have not obsessed nearly to the extent I was before.  So here is my 2-part question:On the Zoloft, I am very perfectionistic.  I always feel like something is on my clothes, or in my hair, etc.  So I will keep checking it to make sure.  Would this likely be just an increase in the GAD and ADHD from the Zoloft causing me to do these things, or some other problem? The second part to the question: Could it be possible that my serotonin levels are fine, and maybe even a bit high in places like you said, and my dopamine levels and norepinephrine levels are low causing the hyperactivity and GAD problems?  I can only figure this because of my response to these meds.  I am scheduling an appointment with my G.P.  in a few days, and I was thinking of recommending Effexor XR to replace the Zoloft.  I know this is serotonin based too, but it seems that it is good for GAD, from what I hear and read.

I would appreciate any response to these questions sir.

ANSWER:

You likely have overactive serotonin 1 (GAD) and serotonin 2 (PTSD) receptors.  Ritalin and Zoloft worsen the anxiety of the GAD, sometimes of PTSD.  BuSpar lowers the overactivity of serotonin 1, but in many patients makes PTSD worse.  The medication I use for people like you is to add Remeron – which lowers the serotonin 2 overactivity.  The combination you’re on plus Remeron could be extremely effective.

From what you wrote, I suspect the OCD and/or OCPD are likely present as well – worsened by your current combination of medications.  It is common for people to have multiple diagnoses.

Effexor may work in high doses.  Some physicians and patients get good results on high doses (300-600mg daily).  I haven’t seen many benefits; both side effects and withdrawal symptoms are of concern, and a problem for most patients.



 

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QUESTION:

Dear Dr. Heller,

Do you think they are any closer to coming up with a cure for GAD?

ANSWER:

The GAD is mostly a genetic disorder, especially the cognitive component (mind always going, persistent worry). BuSpar is a very effective medicine for the GAD, although many patients erroneously consider it ineffective because it doesn’t make all their anxiety disorders go away.  Other medications can help such as Paxil, Effexor and the benzodiazepines. There’s a great deal of work being done on genetics and I would expect that someday a cure will be developed.  This day is likely a long way off, however.  For now the best treatment is medications.