QUESTION:
Dear Dr. Heller,
I understand that you are a very busy and in demand person. I have read your book Biological Unhappiness and feel that my husband probably has the BPD. However, there are some things that don’t quite fit. And, there are criteria in the other causes for biological unhappiness that do fit. He is currently in a really bad period and says that he thinks about suicide all the time. He saw a Jungian therapist for almost 10 years and then had a really terrible depressive episode where he quit therapy, had an affair, and then become so frightened by the suicidal thoughts that he checked himself into a hospital. They kept him for only about three days. Once he felt safe, he was rational again and they felt he didn’t need to be there.
He changed therapists and has been seeing someone for about four years now and things were going pretty well until about April of this year when he started getting stressed about money and his job/lack thereof. Now he’s back to almost as bad as he was four years ago when he went to the hospital. I need to know if there is a doctor/psychiatrist in our area that can help him using your methods. He is very sensitive to medications and chemicals of all kinds – MSG and nitrates in food seem to make him sick with severe stomach cramps and diarrhea. The normal household cleaners like bathroom cleaner or waxes can trigger great agitation and sometimes anger. So, it is vital that he have adequate supervision and support for using medications because he is so sensitive to chemicals. He has tried some things, but is afraid of most of them or says that they don’t work.
Please, give me your help. I don’t want this bright and basically kind man to kill himself or turn into someone he hates because when he gets like this he says and does things for which he has a hard time forgiving himself.
ANSWER:
The BPD rarely exists by itself, and the other diagnoses he has worsen the BPD, just as the BPD worsens the other diagnoses. I consider the BPD the most significant illness because of the risk of violence and suicide. Generally those with severe intolerance to chemicals like MSG and nitrates have the generalized anxiety disorder also. This could temporarily cause a problem. His depression is scary. If he has the BPD, Prozac 20mg daily for a week followed by Tegretol should have dramatic effects. If the Prozac makes him agitated during the first week he’ll need temporary medication. In my practice I usually prescribe Seroquel in the evening until the patient can take the Tegretol. Sometimes Seroquel is needed in the morning as well.
This page should be of enormous help as well: http://pks.947.myftpupload.com/AskDoc/First-Do.htm