QUESTION:
Dear Dr. Heller,
I am so impressed and heartened by your website. Thank you! I am 35 years old, on social security disability, have nearly killed myself with an eating disorder, and then drugs. I have denied and fought over my diagnosis of BPD since it was made 10 years ago. Being a nurse I found it to be a repulsive label used to describe the most difficult and nasty patients. How could this be me? Over the last year, having sunk to one of the lowest points in my life, I have been forced to re-examine myself. Now I can see that there really isn't one criteria which I do not meet. Just realizing this has been a bit of a relief. I have finally let go of all the anger and resentment towards my caregivers, and accepted that this is where I am. That alone has really helped them help me.
I have made some progress with changing the way I think. However, I still initially respond to stressful situations with hopelessness or inappropriate anger. I can process these feelings over time, but that is not acceptable in a work environment. I have been on Prozac, Paxil and Zoloft, each for prolonged periods. While my doctor felt I was doing well, I was feeling a level of nervousness I could not tolerate. I wanted to go back on Imipramine which I had taken for years. My doctor refused, and until I read your article I did not understand why. The only medications I tolerate seem to be Tegretol, Depakote and Neurontin. I am now on 2400mg of Neurontin, and still feel I could not react appropriately enough at work. Zyprexa and Resperdal help me sleep, but do not help the irritability. I have not taken Haloperidol, but have had severe prolonged akathesia on Droperidol, so I am afraid of that. How would you deal with this situation? Do you think continued cognitive work and spiritual development alone will help me overcome these inappropriate reactions and let me lead a more normal life? Would you add another medication as a substitute for the ones I can not take?
My sincere thanks.
ANSWER:
You almost certainly have the generalized anxiety disorder, particularly the cognitive
component. This is a genetic trait causing persistent worry. It's an elevated
serotonin level, while other areas of your brain have a low serotonin level (or poorly
functioning). This imbalance gets worse when you take an SSRI like Prozac. The key
medication here is BuSpar, which will stop the worry and the overactivity at the serotonin
#1 receptor. If BuSpar also makes you hyper, you likely have PTSD and this responds to
Remeron.
BuSpar (with or without Remeron) will allow you to take Prozac without the side effects.
From there the usual medication regimen works.
Regarding Haldol: It rarely works if the individual isn't on Prozac, and it
won't work if you need Tegretol. What I usually do in situations like yours is use a
low dose of Haldol and see how you do, usually ½ - 1 mg. It's so important that
borderlines have an as needed medication to stop dysphoria (anxiety, rage, depression and
despair) that it's worth a try to see how the individual did.
