Question:
Dr. Heller,
I have been dating a girl for about
1 1/2 years (now my fiancé) who I
believe was misdiagnosed as Bipolar. When
we first started dating she was taking a
small army of drugs: Abilify, Lamictal,
Risperdal, Cogentin, & (I believe)
Lorazepam (it was a benzodiazepine,
that I know for sure). Anyways, with
all of these drugs, she was basically a
zombie most of the time.
Issues I noticed were: shuffle walk,
excessive tiredness, bad memory,
periodic hand shaking, lack of pain
response to high temperatures, and
occasional bursts of anger.
I spoke to her psychologist, and initially
she agreed to work to reduce these drugs. I
got the feeling she wanted my girlfriend to fail,
because she insisted almost all of these drugs
could be quit cold, and that any resulting
problems would be "proof" that she
needed to take the medicine. Regardless
of her recommendation to quit cold, we tapered
off the drugs one at a time.
After my fiancé managed to successfully quit a
couple of these drugs with no problems, her
psychologist did something strange, and refused
to see/speak to me any more.
Anyways, despite her psychologists' refusal to
work with us, we have managed to get her off
daily use of all of the above listed drugs.
Her psychologist still believes she is taking
Abilify and Risperdal daily.
All of the side effects listed above have
resolved, with one exception, the periodic
bursts of anger. Initially her anger
bursts got more intense, but we experimented
with several different combinations of amino
acids/OTCs with known effects on Serotonin,
Dopamine, and epilepsy while using the
Risperdal as needed to keep things under control.
She now takes 100mg 5-HTP, 500mg L-Taurine, &
50mg Benadryl once daily in the evening. This
combination seems to work best for her, and
greatly minimizes the severity and duration of
her anger outbursts when they occur. Actually,
what seems to be the most effective ingredient
in that list may surprise you (L-Taurine). At
1000mg it works better, but makes her more tired,
so we are staying at 500mg for now.
Anyways, after about a year of being off her
drugs, I am more sure than ever that she is
BPD instead of Bipolar. I read your list of
BPD issues, and it matches her almost perfectly.
I have never seen any hint of depression at any
point in time.
Currently, the only
prescription drug we still use from her original
group of drugs is Risperdal. We found that
0.5mg usually helps prevent an episode if it
is an imagined problem or obsessive thinking
about problems from her past. However,
when an episode is triggered by a perceived
rejection by me, 1.5mg to 2mg (in extreme
cases only) is needed to get things under control.
We also discovered (the same as your other
clients) that chewing/crushing the Risperdal
and dissolving it in her mouth does speed up
the response time. However, the problem,
as you might expect is the hour before the
drug really starts to kick in can get a bit
out of control.
We are considering trying the Haldol after
reading your site, perhaps at a little lower
dosage based on the fact that she usually needs
only 1.5mg of Risperdal vs. your
3mg recommendation.
My main question for you that I have not been
able to answer from your web site is: have you
seen a case of BPD where daily prescription
SSRI's were not necessary, and your recommended
list of treatments for episodes was enough to
do the job?
Thanks,
Dr. Heller's Answer:
If she does indeed have the BPD
the right medications make a huge
difference. SSRI's don't work
equally as a class. Prozac (fluoxetine)
is profoundly superior, likely due to its
effects on the glial cells. The right
dose of Prozac stops the unproved mood
swings, chronic anger or irritability,
emptiness and boredom. Prozac
(fluoxetine) is inexpensive and rarely
has side effects. If a patient
just can't take Prozac (fluoxetine), I
will usually prescribe high dose Effexor
(venlafaxine). The symptoms Prozac
(fluoxetine) stops, will otherwise destroy a borderline's
life. Almost everyone I've treated
for the BPD with Prozac, and subsequently
stopped taking it, eventually wished
they hadn't stopped.
The as needed medications are
different. Haldol (haloperidol)
is cheaper, works more quickly and doesn't
cause weight gain.
Being groggy most or all the time to me
is not an acceptable medication regimen. It
may happen in the early stages of treatment
or during episodes of severe dysphoria (anxiety,
rage, depression and despair), but otherwise it's
not acceptable.
As with everyone, making the correct diagnoses
and treating them comprehensively is crucial.
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