- Is My Daughter On Enough Medication?
QUESTION:
Dear Dr. Heller,
I wish so much that I could have a telephone consultation with you so I could get the information I need. If a telephone consultation is possible, please email me back to let me know when I might call. I’m willing to compensate you for your time. Perhaps I could conference with you and my daughter’s psychiatrist three ways; I have that option on my phone.
Bottom line, my 19-year-old daughter is just as you describe a person suffering from Borderline Personality Disorder in your book, “Biological Unhappiness.” After reading your book, I asked her doctor to consider reading it too, which she did. She felt you made good sense and was willing to try the meds you recommend. But she put my daughter on only 10mg. of Prozac to start, gradually worked her up to 30mg, and then started her on Neurontin, but only a 300mg. starting dose.
When my daughter got more depressed on these doses, she upped the Neurontin to 600mg. There was an immediate improvement but not enough. A few weeks later, she took over the counter sleeping pills and a few days after that, checked herself into a hospital because she was afraid of what she might do to hurt herself. (She’s a cutter/scratcher.) They upped her to 900mg. of the Neurontin in the hospital, but my sense is that she’s not on nearly enough Prozac, and that maybe the Neurontin would also work better if she were on more Prozac. Maybe she needs more Neurontin as well.
Do you think all or some of these statements may be true?
Furthermore, her ADD restlessness seems worse than ever, but she claims that Ritalin and/or Adderall make her too nervous. Do you think this effect might go away if she’s on the correct amount of Prozac and Neurontin? I would so appreciate the opportunity to talk with you and her psychiatrist together. Please help us. Thank you.
ANSWER:
I’ve been extremely disappointed in Neurontin for the BPD. If the individual with BPD also has ADHD, Neurontin can make them worse. The Prozac/Tegretol combination is the best in my experience. I treat cutters very aggressively because they are in so much pain. They cut to relieve the neurological pain of dysphoria (anxiety, rage, depression and despair) like we all do to relieve the neurological sensations associated with poison ivy or insect bites – the body is further injured, but the horrible sensations feel better.
If the stimulants make her worse, she probably also has the GAD which would require BuSpar or a beta-blocker like atenolol or metoprolol.
The BPD symptoms that Prozac resolves are unprovoked mood swings, chronic anger, emptiness and boredom. If those symptoms persist I increase the Prozac until they are gone.
