Why Do You Use Old Drugs? * Dr. Leland Heller is a family physician who has treated thousands of patients with the Borderline Personality Disorder. BPD is a medical disorder and that this and other Biological Unhappiness disorders are treatable with medication first and then by retraining the brain * Biological Unhappiness * BiologicalUnhappiness.com

WHY DO YOU — USE OLD DRUGS? Why Do You Use Old Drugs? Ask The Doctor Dr. Leland Heller Biological Unhappiness Why Do You Use Old Drugs? Why Do You Use Old Drugs? WHY DO YOU — USE OLD DRUGS? Why Do You Use Old Drugs? Question: I showed my psychiatrist your medication plan for borderlines like me.  He said you are using old drugs to treat the BPD when we now have much better newer drugs.  He was very adamant that you were wrong to use these older drugs. Dr. Heller’s Answer: The most important reason is many “older medications” is that they work, and they work far better than any of the newer medications.  It helps of course that 30 pills of Prozac (fluoxetine) 20mg or 40mg costs $4 a month, that 30 Tegretol (carbamazepine) 200mg pills costs $4 a month and that Haldol (haloperidol) also costs $4 per month.  This has made BPD treatment much more cost effective and manageable. I often give 6 days of Zyprexa (olanzapine) 5-10 to start treatment.  This is a newer medication that costs ~ $12 per pill.  If a patient needs a long term antipsychotic, I’ll use the newer medication Abilify (aripiprazole) which costs ~ $33 per pill. Risperdal (risperidone) 3mg just went generic, but remains a remarkable medication for the BPD.  No matter how severe the dysphoria (anxiety, rage, depression and despair), borderlines already taking Prozac (fluoxetine) and Tegretol (carbamazepine) will always respond 24 hours later with the Risperdal. If the patient is allergic to Tegretol (carbamazepine), I will try Depakote (valproic acid or valproate) first, Topamax (topiramate) second and Lamictal (lamotrigine) third.  Tegretol (carbamazepine) and Depakote (valproic acid or valproate) are “old” drugs, while Topamax and Lamictal are “newer drugs.” If Prozac (fluoxetine) makes the individual worse, the cognitive generalized anxiety disorder is usually the problem and BuSpar (buspirone) needs to be used so that Prozac (fluoxetine) doesn’t worsen the GAD.  If truly unbearable side effects occur from Prozac (fluoxetine) such as a rash, I’ll usually use high doses of relatively older drug Effexor (venlafaxine) or the new Effexor (venlafaxine) derivative Pristiq (desvenlafaxine).  BuSpar (buspirone) is an “old drug” that costs approximately $12 per month. The “older drugs” Wellbutrin (buproprion) and lithium are rarely effective for the BPD.  The older antidepressant Remeron (mirtazapine) is useful for PTSD (post traumatic stress disorder), which can sometimes be worsened by BuSpar (buspirone) and for severe sleep problems. Some of the other newer, and very expensive medications, just don’t work as well for most individuals with the BPD.  They include the antidepressants Cymbalta (duloxetine) and Lexapro (escitalopram), and the mood stabilizers Topamax (topiramate), Keppra (levetiracetam), and Lamictal (lamotrigine).  Geodon (ziprasidone) and Seroquel (quetiapine) have been ineffective, although the newer drug Seroquel (quetiapine) can help for severe sleep problems. I prefer the newer forms of the “old” medications for ADHD because they are more long lasting and easier to use.  In children I prefer the methylphenidate molecule (a.k.a. “Ritalin).  If finances are a concern generic Ritalin is used, otherwise I prefer the newer delivery systems and “isomers” such as Concerta, Focalin, and Daytrana.  In adolescents and adults I prefer the dexedrine molecule (usually prescribed as “Adderall.”   I greatly prefer to new form Vyvanse because of its lower addiction and abuse potential.  Sometimes Adderall XR or generic Adderall is necessary.  The newer drug for ADHD, Strattera (atomoxetine), has been disappointing.  When it works it lasts 24 hours and it’s not addicting.  In my experience it only works ~20% of the time, makes many people irritable or hostile, and it’s expensive (~$300 per month). As you can see I use a mix of older and newer medications.  I want to use the most effective medications, particularly if they are now inexpensive.  The same philosophy is in all areas of medication including high blood pressure, heart disease, diabetes, asthma, heart failure, etc.  When possible we use older, less expensive medications with good track records in the literature, saving the newer more expensive medications for conditions where older, less expensive, and equally effective medication options are not available. The longer the drug has been on the market the more information we have about the safety and potential risks.  Newer drugs haven’t had the time for this information to be compiled.  For this reason, many physicians like to wait one to two years prior to trying a new drug. Why Do You Use Old Drugs? 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Ask the Doctor Home Why Do You Use Old Drugs? MENU: Why Do You Use Old Drugs? Why Do You Use Old Drugs?Screening Test Why Do You Use Old Drugs?“Ask the Doctor” Why Do You Use Old Drugs?(BPD)Borderline Personality Disorder Why Do You Use Old Drugs?Annual Updates Why Do You Use Old Drugs?Biological Unhappiness Disorders & Official Criteria Why Do You Use Old Drugs?Dr. Heller’s C.V. & Picture Why Do You Use Old Drugs?How Dr. Heller Got Involved Why Do You Use Old Drugs?If You Want to See Dr. Heller as a Patient Why Do You Use Old Drugs?Testimonials Why Do You Use Old Drugs?Table of Contents for the Book ‘Biological Unhappiness’ Why Do You Use Old Drugs?How to Order Why Do You Use Old Drugs?“Life at the Border” Why Do You Use Old Drugs?Why Read ‘Biological Unhappiness’? Why Do You Use Old Drugs?Goals Why Do You Use Old Drugs?AD(H)D and Relationships Why Do You Use Old Drugs?BPD, Bipolar or ADHD? Why Do You Use Old Drugs?Suicide Why Do You Use Old Drugs?What if BuSpar makes me anxious or ill? Why Do You Use Old Drugs?A Suicide Attempt Per Minute in the US Why Do You Use Old Drugs?Grandparents raising Grandchildren Why Do You Use Old Drugs?Information About Children Why Do You Use Old Drugs?What Signs are there that Someone May ‘SNAP’? Why Do You Use Old Drugs?TV & Cartoon Characters with Depression & Other Disorders Why Do You Use Old Drugs?Dr. Heller’s Office Website Why Do You Use Old Drugs?Dr. Heller’s Lectures Why Do You Use Old Drugs?Mentally Healthy People Why Do You Use Old Drugs?Retraining the Brain Why Do You Use Old Drugs?Today is a Gift Why Do You Use Old Drugs?Reviews Why Do You Use Old Drugs?Links Why Do You Use Old Drugs?Webrings Why Do You Use Old Drugs?Site Index Why Do You Use Old Drugs?Home Why Do You Use Old Drugs? Why Do You Use Old Drugs?   Video DVDs now available!   Why Do You Use Old Drugs? You can watch and listen to Dr. Heller in the comfort and convenience of your own home.  Provides full explanations and treatment descriptions of Borderline Personality Disorder (BPD) – 90 minutes, other Biological Unhappiness disorders – 90 minutes. Click here to find out more about Dr. Heller’s educational videos. Why Do You Use Old Drugs? “Biological Unhappiness” “Open this book and it will open your mind.  By combining proven medical procedure with hope and inspiration, Dr. Heller has made a significant difference in thousands of patients who had little hope for recovery.  “Biological Unhappiness” contains critical information for those who have lost hope.”Zig Ziglar, motivational speaker, author, See You at the Top, Over the Top, Success for Dummies, Raising Positive kids in a Negative World. Why Do You Use Old Drugs?    Why Do You Use Old Drugs? Dr. Leland Heller  Dyslimbia Press, Inc. 1713 US Hwy 441 N, Suite E • Okeechobee, FL  34972 • 863-467-8771 Email: Hours: M-Thu. 8:30AM-5PMFri. 8:30AM-12 Noon*(*During November through April, the office is open until 3PM on Fridays.) All material not explicitly credited otherwise is copyrighted © 1999-2011 Dr. Leland Heller. All Rights Reserved.  May not be duplicated without the permission of Dr. Leland Heller or Dyslimbia Press. Biological Unhappiness™, BiologicalUnhappiness.com™, & Dyslimbia Press™ are trademarks of Dr. Leland HellerDesigned and/or hosted by the webmasters at: US-Webmasters.com (TM) Start here to find it FAST!(TM)