QUESTION:
Dear Dr. Heller,
Our 37 year old daughter has been under psychiatric care for 5 years with 7 O.D.s and has been hospitalized since Oct. 1 at Menninger Clinic in Topeka. She has been on many medications over the years including SSRI's, Ativan, lithium carbonate, Risperdal (bad reaction), etc. and now since Oct. 19 is taking about 200 mg. Effexor and Seroquel along with an Rx for sleeping aid as needed. After her last O.D. before Menninger Clinic we suggested to the psychiatrist through the social worker that we doubted that she would have been any worse with no medications at all. She had 6 Rxs at the time. She then was diagnosed for the first time with BPD and was off any medication for about 8 days before being admitted to Menninger. She seemed much improved. However, she now seems to be getting worse at the Menninger Professionals in Crisis program despite what she feels to be is very helpful therapy sessions. They weaned her off of Ativan and then went to Seroquel after a bad downturn triggered by psychodrama. We saw her in her worst state, and 3 hours later, after a Seroquel, she seemed to be fine. However, the Seroquel does not seem to do much anymore and dysphoria and suicidal ideation run rampant. I have asked them about trying Tegretol as you so often recommend, but so far get no reaction one way or the other. Are there any newer variations of medications similar to Tegretol? Do you think it worth a try?
ANSWER:
Tegretol by itself only reduces the severity of "behavioral dyscontrol."
It's the combination with Prozac that makes the greatest difference - and for some
reason if Prozac has been in the body for 7 days first, then the Tegretol works in just
hours.
Some medications such as Seroquel and Risperdal work when initially taken and then only
work when they are discontinued. It's a strange but very real phenomenon.
Tegretol can cause the liver to increase it's metabolism of other medications, and
can cause a serious bone marrow problem in approximately one in 85,000 people who take it.
The other epilepsy medications (a.k.a. "mood stabilizers") such as Depakote,
Lamictil, Topamax and Neurontin have their own risks as well, and don't work as well
as Tegretol. You can find out more about
Tegretol and the BPD
here.
There is a long acting form of Tegretol called "Carbatrol." Interestingly some
patients do better on generic Tegretol and some on Carbatrol. It's unpredictable.
If patients need Tegretol regularly (especially common during adolescence), I've seen
the greatest success when the blood level is in the upper third of the normal range.
