WHY DID MY DAUGHTER NEED BOTH EFFEXOR AND ADDERALL? 
Ask The Doctor Dr. Leland Heller Biological Unhappiness 
WHY DID MY DAUGHTER NEED BOTH EFFEXOR AND ADDERALL? 
Question: This is a two part question: 1) My daughter is 15 and has borderline personality disorder. Over last summer we took her off Adderall and Zoloft. Then we started ramping her back up on Effexor to affect the serotonin and norepinephrine. Recently we ramped her back on the Adderall. The last week both Effexor and Adderall have been in effect. For the last week her mood has been amazing. She is positive, happy, and energetic. I have seen no negativity, no despair. Her lethargy is gone. Her carbohydrate craving is gone. She is taking greater and more appropriate interest in her personal hygiene. I don’t see Adderall indicated for BPD but as it is now all three of her major neurochemicals seem to be supported: Serotonin, norepinephrine, and dopamine. Can you explain this drastic change? Just 4 weeks ago she was cutting herself for the first time. So to go from that to this is amazing. Honestly, it has been so soon, I hate to have “real hope” that it will last. But I can’t remember a time when I’ve seen her truly happy. A week straight is a dream. So I guess I’m looking for a scientific explanation as to why these drugs might work the way they do in this positive of a fashion. 2) It took me a long long time to put my daughter on medications. In her early years, she was diagnosed with many things and with psychiatrists spending 30 minutes to 45 minutes on her before handing her a drug. So I rejected those diagnoses because I was afraid to put her on medication with out scientific evidence or without someone spending time on her to really know what was going on. She was diagnosed with depression, anxiety, and ADHD all separately with different doctors. I even took her to a neurologist who looked at me and said “how do you know all of her symptoms are not normal.” The only testing he did was some office tapping and testing reflexed, balance, etc. She has hashimotos as well so I’ve approached this from an endocrine side as well, asking endocrinologists to test her hormones. Now she has been with a psychologist long term (for years) who really understands what is going on. So I feel more comfortable now. My question is, Are there any actual medical tests that can check levels of certain hormones or neurotransmitters or check for gene mutations that can identify positively the borderline diagnosis? This would have helped me tremendously to give my daughter the appropriate treatment earlier and will help other scientific minded parents. Many thanks! Dr. Heller’s Answer: There are no tests available, it’s all done by criteria. Approximately 50% of those with ADHD have the BPD and vice versa, so that would explain why she needed both the Effexor and the Adderall. I can’t possibly overestimate how important treating both conditions is if they are present. Comorbidities will usually define success or failure of BPD treatment. Everything you have wrong with you makes everything else you have wrong with you worse. Treating episodes of dysphoria (anxiety, rage, depression, despair) will likely be necessary as well, particularly with relationship problems. Effexor works extremely well for some people, especially in high doses. Whether it has anything specifically to do with the actual neurotransmitter effects remains conjecture. Other medications that affect serotonin and norepinephrine don’t have the same effect. Effexor can have a severe withdrawal syndrome. The official criteria for ADHD can be found at: http://pks.947.myftpupload.com/AD-H-Dcr.htm and for the BPD at http://pks.947.myftpupload.com/DSM.htm. 
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