Question:
I've been using Prozac for
about 10yrs but its not working as
well. I just found your articles on
adding Tegretol to the Prozac. In your
opinion, is augmenting the Prozac with
Tegretol the best way to go?
Dr. Heller's Answer:
It depends on the underlying
diseases and comorbidities. If an
individual with just the BPD in my practice
is doing well on Prozac and has a
dysphoric episode, I prescribe a dose of
Haldol, usually 2mg. If that
doesn't work, I'll give a dose of
Tegretol. If that doesn't work, 3mg
of Risperdal will stop the
dysphoria 24 hours later.
If the individual needs Haldol on a
regular basis, is going through
excessive stress, is having bad dreams
or wakes up dysphoric, or has persistent
mood swings, then I'll prescribe a regular
Tegretol dose.
In my experience, the Prozac (fluoxetine)
/ Tegretol (carbamazepine) combination is
by far the best medical treatment for
the BPD. It's also very inexpensive
and rarely has significant side
effects. There are other combinations
that can work very well also, but I don't
usually use them. They are:
1) Prozac (fluoxetine) with Zyprexa
(olanzapine). This works well, and
has literature to back it up. Zyprexa
is enormously expensive and can cause
tremendous weight gain as well as diabetes.
2) High dose Effexor (venlafaxine)
(usually 450-600mg daily) either by itself
or with a weight neutral antipsychotic like
Abilify (aripiprazole). Expense and
severe withdrawal symptoms are a
problem. Effexor (venlafaxine) can
cause significant high blood pressure and
side effects commonly limit its
use. Some practitioners believe
Effexor (venlafaxine) is the best medication
for the BPD. I'd love to see a head to
head study comparing Effexor
(venlafaxine)--with or without an
antipsychotic--with
the combination of Prozac (fluoxetine)
with and Tegretol (carbamazepine) at a
therapeutic dose that stops the target symptoms.
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