Question:
My daughter, who is 18, has been having problems since she was 11 yrs old. It began with her becoming withdrawn from the family, moody, being disruptive in school, etc. We have been seeking treatment for her since that time without much success.
We tried Adderall, which made her zone out. She was then prescribed 10mg. daily/Prozac for depression, at which time she developed an eating disorder. The dosage was increased to 60mg daily and we only got the side effects with no real relief from the symptoms. Then she was switched to Zoloft and became bi-polar, having extreme mood swings several times per day (which she had not had before). She was then prescribed Depakote along with the Zoloft for the mood swings. BuSpar was also added at this time. It's hard to say if the BuSpar was effective. The Depakote made her so tired she actually fell asleep during her SAT test at school and her hair began to fall out.
We switched doctors and felt it would be best to start her at square one and weaned her from all the medications. It became quite apparent that she was suffering from severe depression at which time he prescribed Celexa. The Celexa seemed to work pretty good for awhile but every two to three months we have had to increase the dosage to get the same effect. She is now taking 80mg/Celexa per day.
Please help us. Her mental state is very fragile right now. She is extremely irritable and has made some very bad decisions because of her impulsivity which has added to her stressed state. Her thinking and reasoning is not realistic. She says her mind races all the time. It's as if her mind can't slow down long enough to think about any one thing. She constantly shakes her leg as if she is about to jump out of her skin when she's seated.
She is quickly acquiring a taste for alcohol. When she does drink, she rages and changes personalities to an extreme. She has no interests and few friends. She seems numb to anyone else's pain but her own. She doesn't seem to even know what her feelings are or who she is.
She is a beautiful, creative person with an extremely dry wit, yet she thinks she is a bad person. She is extremely bright, yet she cannot get through algebra (she has taken it twice and had months of tutoring but just doesn't get it and even basic math presents problems for her. She puts on a "front" to her friends, but keeping up the facade at school is so exhausting. She then comes home and doesn't want anyone to even talk to her.
The only thing that seems interesting to her is going to parties -- everything else is boring. She was in therapy for months due to the eating disorder, but really didn't have anything to talk to the therapist about as far as any trauma or life problems. Her doctor seems to think her problems are purely biological due to the family history.
She is constantly tired and sleepy and will sleep up to 20 hrs per day. She craves carbohydrates but when she eats a lot of them she gets very mean and irritable. She has a high pain tolerance. She has cut herself before during one of her depressed episodes and wanted to die. She is miserable and it is tearing the rest of the family apart.
Since she is 18 I feel our time is quickly running out to help her. None of the meds seem to have been very effective. She is at the maximum dosage of Celexa and her doctor won't increase the dosage any more.
What now? Is she doomed to a life of pain and trouble or is there something that can help her?
Possible diagnoses from the screening test:
(Attention Deficit Disorder)
(Borderline Personality Disorder - BPD)
(Cyclothymic Disorder)
("Fractured Enjoyment")
(Obsessive Compulsive Personality Disorder - OCPD)
(Generalized Anxiety Disorder - GAD)
Dr. Heller's Answer:
Assuming the diagnoses from the screening test are accurate she needs a combination of medications. Cutting generally implies the BPD.
This is an approach I probably would take if I had a patient like her:
BuSpar for two to four weeks should make it possible for her to take Prozac or another SSRI without increasing her anxiety. I much prefer Prozac for many reasons.
The subsequent addition of Tegretol to stop her chronic dysphoria (anxiety, rage, depression and despair). I have found that most adolescent cutters need both Prozac and Tegretol together.
Once the Tegretol blood level was good I’d treat her ADHD either with a psychostimulant.
Because of the fatigue her thyroid profile, CBC and ferritin (looking for iron deficiency) and B12 levels need to be checked.
|
Videotapes now available!
