QUESTION:
Dear Dr. Heller,
I am twenty years old. I was diagnosed with dissociative identity disorder a few months ago. I have had an anxiety disorder since I was thirteen years of age. Prior to last June I had a slight traumatic experience where I felt excessive fear to the point where it felt like I was outside my body. I was hospitalized for the event and put on medications. Gradually I lost all physical and emotional feeling. I am on Celexa and Zyprexa. I'm not sure if they are helping me or adding more trouble to my situation. I'm not very satisfied with my current doctor's instructions, and because you seem like you offer sound advice, I would like to know if there are medications that I don't know about that can help, and what your opinions about Celexa and Zyprexa are.
Thank you.
ANSWER:
I've taken care of many patients with dissociative identity disorder (DID -
"multiple personalities"). Every one also had the borderline personality
disorder (BPD) - which makes sense since severe emotional trauma causes both disorders.
With three exceptions I do everything the same for DID patients as I do for others with
the BPD:
1) Keep the Tegretol level in the upper third of normal
2) Place the patient on Remeron to improve the PTSD (post-traumatic
stress disorder) symptoms - particularly inability to sleep.
3) Make a safe home environment, especially for sleep. Motion detectors
are helpful. Some patients get dogs like a German Shepherd.
In my opinion, Prozac is needed for those with the BPD to stop the unprovoked mood swings,
chronic anger, emptiness and boredom. I consider it significantly superior to Celexa. Part
of it's effect may be improvement in the brain's support cells (called
"glial cells").
The
screening test
I use for my patients can be extremely
useful for diagnosing and treating other neuropsych problems.
I rarely prescribe Zyprexa for those with the BPD because of the weight gain and the
complaint that "I don't have any feelings" many individuals describe.
