Question:
What About BPD Treatment Using Lexapro Wellbutrin or Cymbalta?
Dr. Heller's Answer:
Lexapro is in the SSRI class. It’s a form
of Celexa (citalopram). Clearly increasing
serotonin has some benefits for the BPD, as all
SSRI’s help to some degree. The uniqueness
of Prozac (fluoxetine) is likely due to its effects
on the brain’s glial cells. While the other
SSRI’s occasionally work as well as Prozac
(fluoxetine), it’s uncommon. For most
individuals with the BPD, Lexapro (escitalopram) is
more expensive and less effective than
Prozac (fluoxetine). At the right dose, Prozac
(fluoxetine) eliminates unprovoked mood
swings, chronic anger and irritability, emptiness, and
inappropriate boredom. It also
dramatically reduces rejection sensitivity and chronic
unhappiness. All SSRI
antidepressants can worsen the cognitive generalized
anxiety disorder if it is present. They
can also cause difficulty with orgasms, although this
is usually treatable. Lexapro causes
this side effect less often.
Wellbutrin (buproprion) appears to work by increasing
dopamine and noradrenaline. It
can be very stimulating and can help with ADHD and the
"blah’s" (particularly those
caused by SSRI medications). It can make the cognitive
generalized anxiety disorder worse.
Without first treating the BPD, Wellbutrin
(buproprion) often increases the frequency and
severity of BPD dysphoria (anxiety, rage, depression
and despair) episodes - presumably by
increasing limbic system dopamine levels. It’s a great
medication for the right person, and
it can extraordinarily helpful for orgasms and/or the
"blahs’s" that can be caused by SSRI
medications when taken in combination with the SSRI
medication.
Cymbalta is a newer antidepressant that seems to
affect both serotonin and noradrenaline.
It’s marketed for helping reduce diabetic neuropathy
pain. Overall I’ve been
disappointed in it. Cymbalta does work for some
individuals, with or without the BPD, but
not commonly. The few with the BPD who have done
extremely well have been on very
high doses. In my experience, those without the BPD
respond approximately 20% of the
time to Cymbalta. For those 20% it works extremely
well.
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