QUESTION:

Dr. Heller,

I am so grateful for your books. I have suffered much with BPD. I was told that it is a personality disorder and treated very badly by counselors and hospital staff all my adult life (30 years). I've always said "there is something wrong with my brain". No one would listen. I have also been diagnosed with A.D.D. and G.A.D. among other things through the years. I have a bad effect with Prozac, even at 5 mg. You said to treat the underlying G.A.D. first so is Klonopin good for this since it is an anti-seizure med? I have been taking it as needed for a few years off and on. I am hoping this would help me to be able to tolerate the Prozac. I do not have medical insurance since I am not able to hold down a job due to these conditions so I want to do my homework before going to my doctor with this request. Thankyou so much for helping me to finally understand what has been going on with my brain. I have hope.

ANSWER:

Klonopin won’t do that for you, it just "numbs" the fear sensations.

It appears that the GAD is due to a genetic alteration in the serotonin 1 & 2 receptors that cause them to respond too easily to stimulation. The only medication in my experience that works well is BuSpar. Sometimes very low doses are needed initially. Once the individual has been on the BuSpar (usually 15mg twice daily) the patient can tolerate Prozac without difficulty.

With rare exceptions, it’s better to use BuSpar before the Prozac so the person doesn’t become afraid of Prozac. Timing of medications can be as crucial as dose and which medication is used.

It’s very common to find individuals with the BPD, ADD, and the GAD coexisting. I’ve found that treating them all comprehensively is a key ingredient for recovery.