QUESTION:
Dear Dr. Heller,
I was diagnosed with BPD this past March. I have struggled with depression, anxiety,
and suicidal ideation since age 21. I am now 34. I was at one point with very high
functioning. I made it through college and graduate school. I am a physical therapist and
have done very well in the field. I became a manager of a rehab hospital but hated
managing. I left the field and went in to pharmaceutical sales and things started going
down hill. I had surgery and had many complications. All along depression and anxiety were
getting worse. I became extremely suicidal and went in to the hospital. I've been out of
work for a year and half between all the physical and emotional problems. Physically I'm
OK to return to work, but not emotionally. I have been consistently in therapy since 1991.
My first therapist retired and I left my second therapist after several years . I've been
with my current therapist for a year and a half. I've also had 8 weeks of an intensive DBT
training. I have several questions.
1. Does Celexa work as well as Prozac does for BPD? I've been on it since March 40-60mg
and it hasn't changed my moods or suicidal ideation.
ANSWER: I don't believe Celexa is anywhere near as effective for the BPD. I'm
highly suspicious that what makes Prozac more effective is it's ability to improve
the functioning of glial cells - these are the cells that support the neurons. 90% of the
cells in your brain are supportive glial cells, not neurons.
2. What do you suggest for sleep? I can fall off to sleep OK, I just can't stay sleeping.
Klonopin makes me more depressed. Ambien doesn't work, and Ativan helps some. However, I'm
afraid about addiction. I have a rare colon disorder where I don't have any peristalsis,
so I have to be careful about not taking things that cause constipation. I have to take 5
dulcolax a night in order to move my bowels.
ANSWER: Most BPD patients sleep very well on the Prozac/Tegretol combination. Some with
PTSD need Remeron, at least for a while. Seroquel 100-600mg nightly will usually take care
of the other sleep problems.
3. I also take Neurontin 3x/day - 300mg a.m., noon, and in the p.m. I take 900mg. I also
need the Neurontin because I have interstitial cystitis. I take Elmiron as well.
ANSWER: I've treated many interstitial cystitis (IC) patients with good results.
Every one also had the BPD, which needs to be treated aggressively. I'm highly
suspicious IC is a herpetic infection, like shingles that affects the bladder. Drugs like
Zovirax, Famvir and Valtrex have worked extremely well for my patients. Neurontin
generally does very little for the BPD.
4. Is DBT therapy the only answer for BPD? Or, is DBT the best treatment approach?
ANSWER: DBT is an extraordinarily comprehensive and expensive therapy approach that has
been shown without medication to lower suicide attempts and self-mutilation by half. DBT
is not the only answer. There are many forms of therapy that help, particularly those that
emphasize where we go from here. Learning to recognize dysphoria (anxiety, rage,
depression and despair) and treating it medically is extraordinarily important. I
don't believe in rehashing the past, particularly when abuse was present.
5. Could Wellbutrin be helpful in treating BPD?
ANSWER: In and of itself Wellbutrin has very little positive effect on the BPD. Some
individuals on Prozac lose their zest for life {this is different from dysphoria (anxiety,
rage, depression and despair)} due to an imbalance of serotonin with noradrenaline and
dopamine. Wellbutrin can help put this into balance.
Any suggestions?
ANSWER:
I'd recommend you read over the BPD section and FAQ section (part of "Ask The
Doctor") on my website.
P.S. I thought you'd like this one. After being in the hospital, I had three psychiatrists
during an initial evaluation tell me they didn't want to work with me because I had BPD.
Then I finally found one who enjoys working with BPD. After several months of working with
her, she decided that if I didn't leave my current therapist and see just a DBT therapist
that she wouldn't work with me. Now I found a psychiatrist that has a wonderful rep.
However, I'm not sure you can figure out appropriate medications in 15min. My PCP has been
amazing through all of this with me. Without her I would have probably committed suicide.
She has been such a stable force in my life.
Being a PCP has helped me enormously in treating the BPD because I'm used to seeing
the entire patient, and making all their diagnoses and treating them comprehensively. It
usually takes me considerably less than 15 minutes to determine medication changes,
although I don't do the therapy. I look for specific signs of medication need. For
example, a sign that a higher Prozac dose is necessary would be unprovoked mood swings,
chronic anger, emptiness or boredom.
