WHY ARE THE MEDICATIONS MAKING ME WORSE? 
Ask The Doctor Dr. Leland Heller Biological Unhappiness 
WHY ARE THE MEDICATIONS MAKING ME WORSE? 
Question: Dear Doctor, A brief history: depression, suicidal thoughts, anxiety by age of 15. First suicide attempt: 16. In and out of hospitals a lot until my twenties. I seemed to get by in my twenties, but had chronic masturbation to ease anxiety, and lots of depression, crying spells, and two day sleeping marathons. I went on Paxil when I was 34. I’m now 44. I seemed to be surviving. I could work, but that was all. Spent most weekends sleeping. When I got laid off three years ago, I isolated myself, and it led to a drug overdose. I was put on Effexor 300 mg. I spent the last three years yo-yo’ ing between Paxil 60 mg. and Effexor 150-300 mg. I am in a wonderful relationship, but now I cannot seem to hold down a job. I get anxiety attacks or rage, and I end up bolting. Since finding your website, I took a list of meds. to my doctor. He put me on Prozac 40mg., Tegretol 200 meg., and Risperdal .25 mg. The problems I am having seem to have started with the Prozac. I was so itchy I couldn’t sleep and very hyper, but I felt mentally good. I decided to take the Risperdal daily, and then I slept whole days away. Right now I’m awake, but tired, yet hyper, if that’s possible. Do you have any suggestions on the meds? I have a doctors’ appointment in a week. Desperately seeking a middle ground. Answers to screening test: * Are you nervous more than you’re not? * Do you always feel scared? * Does your mind never shut off, and has been that way since you were a child? * Did Prozac make you feel very hyper and/or ill? (Generalized Anxiety Disorder – GAD) A huge yes to all, especially the third one. It takes hours to fall asleep because as soon as I lay down, my brain decides to wake up. On the Prozac, I am more anxious, sweaty, and itching all over when I try to sleep. I stayed up until noon yesterday. Going to my doctor today. Dr. Heller’s Answer: If the borderline personality disorder (BPD) is present, it sounds a lot like the BPD made worse by SSRI’S. It’s unfortunately common, and complicates BPD treatment as they are usually intolerant of increased anxiety. The cognitive GAD (genetic worry) is a genetically heightened serotonin 1A receptor. Individuals with this diagnosis are “cave guarders” — their ancestors would sit vigilantly outside the cave all night looking for danger. SSRI’S increase the activity of this receptor, so the fear and vigilance seem worse. To an individual with the BPD, this makes the dysphoria (anxiety, rage, depression and despair) much worse. BuSpar (buspirone) is the key medication here, as it effectively shuts off the gene. It’s a genetic imbalance that is worsened by stimulants and medications that raise serotonin. Whether or not the BPD is present, BuSpar (buspirone) remains a safe medication to use for the generalized anxiety disorder. When I see a person with your story I’ll generally: 1) Skip the Prozac (fluoxetine) for a day, then resume it at 20mg daily. The Prozac dose can be adjusted later once the individual is more level. 2) Begin Buspar (buspirone) 7.5mg (1/2 pill) twice daily for 7 days, then 15mg twice daily. Take with food! Avoid grapefruit juice! 3) Stop the Risperdal, since it doesn’t seem to work well chronically for most BPD patients 4) Begin Zyprexa: 5-10mg nightly for usually 6 nights. This will usually stop the mind racing and anxiety, but can cause significant weight gain. 5) Stop the Tegretol and resume it a week later, although usually a higher dose because BPD patients with chronic dysphoria (anxiety, rage, depression and despair) usually do much better when they take the Tegretol after being off it for a week. If PTSD (post traumatic stress disorder) is present, the BuSpar (buspirone) may worsen the symptoms. I usually temporarily add Remeron (mirtazapine) to the regimen in these cases. 
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