Question:
This is a two part question:
1) My daughter is 15 and has borderline
personality disorder. Over last summer
we took her off Adderall and Zoloft. Then we
started ramping her back up on Effexor to
affect the serotonin and norepinephrine. Recently
we ramped her back on the Adderall. The last
week both Effexor and Adderall have been in
effect. For the last week her mood has been
amazing. She is positive, happy, and
energetic. I have seen no negativity, no
despair. Her lethargy is gone. Her
carbohydrate craving is gone. She is taking
greater and more appropriate interest in her
personal hygiene. I don't see Adderall
indicated for BPD but as it is now all three of
her major neurochemicals seem to be supported:
Serotonin, norepinephrine, and dopamine. Can
you explain this drastic change? Just 4
weeks ago she was cutting herself for the first
time. So to go from that to this is
amazing. Honestly, it has been so soon,
I hate to have "real hope" that it
will last. But I can't remember a time
when I've seen her truly happy. A week
straight is a dream. So I guess I'm looking
for a scientific explanation as to why these
drugs might work the way they do in this positive
of a fashion.
2) It took me a long long time to put my daughter
on medications. In her early years, she
was diagnosed with many things and with
psychiatrists spending 30 minutes to 45 minutes
on her before handing her a drug. So I
rejected those diagnoses because I was afraid
to put her on medication with out scientific
evidence or without someone spending time on her
to really know what was going on. She was
diagnosed with depression, anxiety, and ADHD
all separately with different doctors. I
even took her to a neurologist who looked at
me and said "how do you know all of her
symptoms are not normal." The only testing
he did was some office tapping and testing
reflexed, balance, etc. She has
hashimotos as well so I've approached this from
an endocrine side as well, asking
endocrinologists to test her hormones. Now
she has been with a psychologist long term (for
years) who really understands what is going
on. So I feel more comfortable
now. My question is, Are there any actual
medical tests that can check levels of
certain hormones or neurotransmitters or check
for gene mutations that can identify positively
the borderline diagnosis? This would have
helped me tremendously to give my daughter the
appropriate treatment earlier and will help
other scientific minded parents.
Many thanks!
Dr. Heller's Answer:
There are no tests available, it's
all done by criteria. Approximately
50% of those with ADHD have the BPD and
vice versa, so that would explain why she
needed both the Effexor and the
Adderall. I can't possibly overestimate
how important treating both conditions is if
they are present. Comorbidities will
usually define success or failure of BPD
treatment. Everything you have wrong
with you makes everything else you have wrong
with you worse. Treating episodes of
dysphoria (anxiety, rage, depression,
despair) will likely be necessary as
well, particularly with relationship problems.
Effexor works extremely well for some people,
especially in high doses. Whether it has
anything specifically to do with the actual
neurotransmitter effects remains
conjecture. Other medications that
affect serotonin and norepinephrine don't
have the same effect. Effexor can have
a severe withdrawal syndrome.
The official criteria for ADHD can be found
at:
http://www.BiologicalUnhappiness.com/AD-H-Dcr.htm
and for the BPD at
http://www.BiologicalUnhappiness.com/DSM.htm.
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