QUESTION:
Dear Dr. Heller,
I was recently told by my psychiatrist that she could tell I was a Borderline the first time she saw me (I'm quoting her). My question is: Is it a well known fact in the medical community or just your opinion regarding Xanax being dangerous for Borderlines to take? She prescribed me Xanax twice (I didn't ask for it). Please clarify this for me. It did help my anxiety but I would like to know what medications (non addictive) you would recommend for GAD so I can discuss this with her.
Thank You.
ANSWER:
The danger in using Xanax (alprazolam) is neither well known nor is it my opinion. Drs.
Cowdry and Gardner at the National Institute of Mental Health published a study on the
effects of Xanax on the BPD. It was published in the Archives of General Psychiatry in
February 1988. The title of the article was "Pharmacotherapy of borderline
personality disorder. Alprazolam, carbamazepine, trifuoperazine, and
tranylcypromaine". This is the exact quote from the abstract: "...those
receiving Alprazolam had an increase in the severity of the episodes of serious
dyscontrol."
Many BPD patients have reported a worsening of their behavior on Xanax. The combination of
panic and BPD is deadly, with a 25% suicide rate. Sometimes there is no choice but to use
Xanax or a similar medication. I will often keep the BPD patient on Prozac with Tegretol
to reduce the behavioral dyscontrol. In that same study Tegretol (carbamazepine) was
helpful. The exact quote is "...those receiving carbamazepine demonstrated a marked
decrease in the severity of behavioral dyscontrol."
If you have the GAD, the best treatment is BuSpar.