Dear Dr. Heller,

I had suffered with this illness for years. It's progressively getting worse. I am a smart girl, used to be a Graphic Artist until I have become disabled because of this illness. I also have Bipolar. I've been on many different drugs, Depekote, Prozac, Effexor, Serzone, Wellbutrin, Buspar, Ativan, Zoloft, even the dreaded Xanax which cause my illness to get a great deal worse.

My dilemma is I feel like I'm doing everything right. I have a Physiologist, Psychiatrist, a case manager and I am in a two hour weekly group study for borderlines. I am only taking 300mg of Wellbutrin and Ativan as needed to sleep or help with my rages. I'm considering Tegretol as an option but don't want to get tired. I fight sleeping and fatigue during the day.

I really don't know what to do, I have considered having some neurological study none but don't know where to go. I live in a small town in South Dakota near Sioux City, Iowa. I've even considered electroshock treatment but I'm afraid it will mess up my already failing memory.

I'm so tired and exhausted fighting this illness, my 9 year old daughter have ADHD and I've witnessed her self-mutilating behavior. I don't want to go into a long thing about everything that's happening, I'm sure you've heard it before. I guess last week getting the gun out and then biting my arm to shreds really has me worried and my husband worried. I don't want to die, I should have everything going for me but I need some answers quick to bring up with these Doctors around here. HELP ME PLEASE. I THINK I'M LOOSING MY MIND. I don't even enjoy sex anymore and that used to be a big thing. I hate this illness. I'm scared to talk about it with anyone, I don't trust anyone. Not even my husband. I really feel alone and empty.

A. You're clearly doing very, very poorly. In my experience, there are medication regimens that may work better. I see people all the time who have been on a huge number of medications, but the dosages, sequencing, and combinations haven't been right.

You need a thorough diagnostic evaluation. Attention deficit disorder may be present in your case as well. The difference when the medications are right can be very, very impressive.

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