Question:
Dear Doctor, can you please help me?
I have been a police officer for twenty years
and witnessed some extremely traumatic
events. I first started showing signs
of depression and anxiety including flash
backs as early as 1991, then again in 1994,
2001, 2003, and now the worst episodes began
approx 16 months ago.
In the early years, I was diagnosed with
depression, and was put on various
antidepressants that made my anxiety
worse. More recently I have been
divorced and been through the family law
court for custody of my sons. I was
given custody however my eldest son was
tragically killed in a car accident in
2006.
In the last 16 months my condition has
worsened and my moods have become very severe
to being depressed to explosive anger over
trivial things. I self medicate on
pain medication and benzos and I will train
in the gym every day for hours. Over
the last year I have broken both arms, my
nose and my foot--one in a work related
incident and the others playing
rugby. Despite my injuries I would
continue to train at the gym with broken
arms despite the pain.
My mood switches quickly from depressed to
explosive anger and aggression. I would
fly off the handle and punch and head butt
the shower wall. Then I would end up
taking Xanax double the normal dose to
calm down.
Last year one doctor diagnosed me with
Bipolar II, rapid cycling. However, the
medication he kept putting me on made me
sick and I eventually changed doctors. My
current doctor has told me that I have chronic
dysphoria and show traits of
borderline personality. Despite this, he
thinks I am reacting to life circumstances.
I am currently on Clonazepam, Bupropion and
Mirtazapine for sleep. Can you assist me
please with a diagnosis? I have a history
of volatile relationships and also have a poor
body image. I suffer badly from anxiety
and self medicate on benzos and pain killers.
Sydney, Australia
Dr. Heller's Answer:
Based on what you've written I
can't tell if you have the BPD or not. If
you do, your medication regimen won't help
much, and the clonazepam can cause you to
lose control of your behavior. The
Remeron (mirtazapine) is an excellent
medication for PTSD (post traumatic stress
disorder), and can be used in combination
with other medications.
If you have the BPD, the Prozac (fluoxetine)
/ Tegretol (carbamazepine) combination works
extraordinarily well. Some individuals
get worse from SSRI medications like Prozac,
this is usually due to the cognitive
generalized anxiety disorder, which will
also need to be treated with buspirone.
The BPD criteria can be found at:
http://www.BiologicalUnhappiness.com/DSM.htm.
Treating mood problems with narcotics is an extremely bad idea.
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