Question:
I have been diagnosed with BPD, PTSD and GAD. I have
been treated with SSRI's which cause increased
irritability and poor rage impulse control. After
taking your screening test, I see I also have
untreated ADD. (My son was diagnosed with ADHD as a
child.)
I had one psychotic episode at age 16 where I
believed I was characters in different famous
childhood stories, like Snow White. I was severely
abused as a child. (I'm now 44.) I had symptoms of
derealization as a child. I've had persistent
problems with paranoia (thinking that people are
talking about me) and social anxiety.
For the last few months I have not been able to sleep
through the night, waking up 4 - 5 times and laying
awake for 1 - 2 hours each time (I stay in bed over
12 hours in order to get 5-6 hours of sleep.)
I am taking a very small dose of Lexapro now, 5 mg,
which has caused me to start losing my temper. My
doctor has suggested Abilify. What do you suggest?
Thank you very much, Dr. Heller.
Dr. Heller's Answer:
Lexapro will also make you worse. The key medication
is BuSpar (buspirone). For most people with the GAD
and BPD, two weeks of BuSpar first will allow you to
take SSRI medications like Prozac and Lexapro without
them making you worse.
Remeron (mirtazapine) could help you sleep well and
protect against BuSpar making the PTSD worse. In
situations like yours I usually continue to prescribe
Remeron for 6-8 weeks and then stop it as long as
Prozac (fluoxetine) is also being taken.
You may need to take Tegretol (carbamazepine) for a
while, particularly at night. I usually wait until
the patient is on Prozac (fluoxetine) for a week
first.
Of all the atypical antipsychotics, Abilify is the
one I prescribe most for continuous use. It seems to
cause the least weight gain. Most individuals with
BPD don't need chronic treatment with atypical
antipsychotics like Abilify, Zyprexa, Risperdal,
Seroquel, etc.
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