QUESTION:
Dear Dr. Heller,
I think I have written to you once before. I gave my son your screening test and he marked all of them that he has the symptoms for, except for the symptoms of ADD. He has seen many psychiatrists and been on all the current meds. Right now he is on Wellbutrin, Effexor, and Tegretols(Carbatrol Time Release). He has difficulty with anger, rage, depression, OCD, panic disorder, and he has not been able to work this past year nor concentrate on college. He is 22.
He was born with bilateral clubbed feet and wore casts, splints and shoes until he was five. He also suffered with allergies from birth. He stopped breathing at the age of 1 month. Doctors said that he was allergic to his formula and put him on Soy (Isomil). He seemed to do better, but by the age of two he was on promethazine with codeine daily, then chlortrimatrine, then Seldane, then two allergy shots once a week from age 8-15.
He now takes Claritin D twice a day. At the age of 14 months he was abused by a babysitter while I was at work. He would hide my shoes, my lunch, and scream when we pulled up to the house. Even on weekends if we would drive by the sitter's house, he would scream. He was there 20 days. I took him to the doctor because he was not eating or sleeping. His father had left me a month before this, also. I thought it was the loss of his dad that was affecting him, but I had to do something. I changed sitters and he was better within two days. What she exactly did to him, I do not know.
I had his sister when he was 22 months old. His father has only seen him twice since he was two. School was very hard on him. He had some balance problems because his top part of his body was longer than the lower part. That kept him off balance for running and sports. I made him try lots of things, but kids and coaches were so cruel to him that he never had a chance. All through school he was picked on and never fought back. He talks about the rage he feels inside being in school. He said it was like a war zone for him. He would walk all around the school to the back each day so he did not have to face the kids in the hallway. His depression, OCD, and rage was very noticeable at the age of l4.
He is now seeing a psychiatrist who is trying talk therapy and medication. She
is trying various things. Could you give me some advice on the drugs he is taking
and what we need to do to keep him healthy? His psychiatrist said that the Tegretol would
kill his immune system. What do we do about this? The work you do is very much appreciated
by me and others.
Thank you very much and I wish we were closer and could have you work with us.
ANSWER:
If the BPD is present - which sounds likely - he'd likely do better with an SSRI
medication like Prozac rather than Wellbutrin and/or Effexor. In my experience, while some
people do occasionally respond to this regimen most don't. BuSpar is the most
effective medication for the GAD, Prozac and Tegretol for the BPD etc.
Make sure all the diagnoses are made and comprehensively treated because everything an
individual has wrong with them makes everything else worse. If BuSpar makes him worse, he
likely has some degree of the post traumatic stress disorder and many of my patients do
extremely well when Remeron is added in this setting.
Regarding Tegretol and bone marrow problems - it does occasionally happen. There is no way
to absolutely prevent it. The risk is extremely low, however. The risk to the immune
system of being so depressed and anxious is also impressive. Depression doubles the risk
of a heart attack, and depression/anxiety problems cause cancer and other infections.
It's not a question of avoiding risk, but of balancing the risks and benefits.