Question:
Dear Dr. Heller,
My spouse is diagnosed as BPD, but our
therapist decided not to offer her that label yet. I do
like the Dyslimbia idea. Her routine medication is
Lexapro, 20mg. During her rages, I've occasionally
persuaded her to take a 1/3 pill of BuSpar, which has
shown quick efficacy (but with subsequent rebound of
some kind, which she disliked). The new emergency
recovery agent of choice at our house is now 10-20mg
Inderal. She says things like: 'wow, I don't feel hot
anymore', approximately 7-8 minutes after
administration, as she suddenly drops the screaming...
If it is placebo, it is a hell of a strong
one. Luckily, this is even an 'approved' indication
(as the BPD person is 'on stage' and experiencing
tremendous fear...) I notice that most psych docs don't
mention Inderal, as perhaps it is deemed to be a heart
med. Anyway, perhaps another option when it is time to
get out the tranquilizer dart gun to get someone back
down onto the ground, and maybe less scary than psych
meds. It is not like the big wet blanket of the
'anxiolytics'.
PS:, I encourage you to drop your
diffidence and push the renaming issue. Having
temporarily worn "Manic Depressive", I can say that
"BPD" is definitely a gratuitous barrier to therapy.
My employer should take a cue from the White House, which
insisted on calling Mr. Cheney's implant a "Power
Pacemaker", not our multi-negative "Implantable De
Fibrillator". What's in a name? Quite a lot
actually.
PPS:, please forgive me if this is in the FAQ
somewhere, I couldn't find it...
Dr. Heller's Answer:
Many of my BPD patients take beta blockers like
Inderal. They help some more than others but are not
the solution. They block the adrenaline that makes the
condition intensify and worsen. I go over this in the
GAD section of "Biological Unhappiness". I've been
trying to name it Dyslimbia for 15 years with no
success, despite hundreds of patients writing in for
that name. I've written numerous letters to this
effect. A number of other names are just as bad such as
"impulsive aggressive disorder" or "impulse dyscontrol
disorder", or to include it as a form of bipolar -
which it clearly isn't.
There are very few people that
improve quickly with BuSpar, you are one of the lucky
ones. Prozac is far superior to Lexapro, once the BuSpar
has been taken for two weeks first (assuming the
cognitive GAD is present). I think the BPD is primarily
due to glial cell malfunction and only Prozac has been
shown to make those brain cells work better.
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