QUESTION:
Dear Doctor Heller,
A couple yrs prior to being Dx with BPD, I was treated for depression {also have major depressive disorder} with Prozac. It lifted the depression, but after 3 months of taking it I started having “racing thoughts”. Since then I have been Tx with Wellbutrin for the depression, but was unable to rest at nite so Zyprexa was added HS. After my last suicide attempt, both of these were discontinued and I have been on Seroquel for the last 4 months. The depression has returned, as well as psychotic behavior. The “thoughts” and psychotic behavior disappear usually within 20mins of taking my Seroquel. My question is: To alleviate the depression, would it be wise to start taking the Prozac again or Wellbutrin.
I am currently searching for a doc, as I have re-located. Until then, I was wondering what your opinion is regarding the medication issue. I was diagnosed BPD a year ago and am legally disabled. I am also a nurse and have “some” extensive knowledge re: meds. And yes, I know it is imperative that I find Tx ASAP…
Thank you.
ANSWER:
What you likely experienced 3 months after beginning Prozac was a dysphoric episode – which would have been more successfully treated with Tegretol. As needed, Seroquel is a good option, particularly since it works for you within 20 minutes. My medication sheet will likely be of use to you, as will my dysphoria instruction sheet You also need to do the screening test ASAP so you can get everything treated comprehensively. Wellbutrin is a good adjunct for persistent depression problems, and its great for assisting with smoking cessation, but in my experience its not a great medication for the BPD.