QUESTION:
Dear Dr. Heller,
My 15 year old daughter started experiencing flashbacks and severe headaches. She made one suicide attempt prior to revealing some of the more minor inappropriate touching at the hands of a step-grandfather. Later more detailed assaults were revealed. Most took place between the ages of 3 and 8 years of age.
There has been 4 months of counseling and she is not making the improvement that her therapist would like. She was started on amitriptyline at first but it was D/C re double vision and yellowish hue. She was then started on Celexa 20mg/day and verapamil 180mg/day for circulation and headache problems. Also Trazodone 25mg, increased to 50mg (insomnia). She did quite well on this combination but then started having a urinary incontinence which resolved when the trazodone was stopped.
She is now using lorazepam, 1-2 mg at hs for anxiety. Imovane was tried to aid sleep but ineffective, even at 10-mg. Choral hydrate was tried at 500mg to 1gm but only made her feel intoxicated and did not bring sleep. She does not like the effects of the sedative medication and would prefer to try to sleep on her own. The problem is that new flashbacks or more detailed flashbacks occur and she is scared to fall asleep due to the night terrors. She is coping better with the flashbacks but they still control her life.
She seems to be grieving so much and has trouble moving on with therapy. She was a 80 average or higher as a student in the past, and for the first 2 months was able to concentrate - getting homework assignments over the phone. She has been stuck since and gets anxious at the thought of going back to school. She does not want to do home schooling. Please advise what medications you have found most success with.
VPA was tried at 250mg dose but she had terrible stomach pains and emesis so it was discontinued. She also has severe allergies and has had trouble with wretching/emesis related to allergies since having a baby.
Please respond as life has to get better.
ANSWER:
Her underlying diagnoses need to be made, and I strongly suspect the BPD is present. My
screening test
may help you discover her medically treatable
diagnoses. The entire BPD and "ask the doctor" sections can give you an enormous
amount of information. If the BPD is present, she'll likely need Prozac and Tegretol.
Amitryptilline has been shown to make the BPD worse.
Once these diagnoses are treated, there are two additional options. 1) naltrexone (ReVia)
has been shown to stop the flashbacks. 2) Remeron - which works for post traumatic stress
disorder.