QUESTION:
Dear Dr. Heller,
I am in desperate need of some help to point me in the right direction, as my case is very complicated. I am a 29 year old female who was hospitalized last August for suicidal ideation in a military facility here in Virginia that was definitely exacerbated by the Effexor XR I was taking.
I have been in psychiatric treatment off and on since I was 14, initially for panic attacks and family problems. I left the hospital with the diagnosis of dysthymia, borderline traits, and major depression. I was put on Prozac, Neurontin (for mood stability) and Klonopin prn. Then I was discharged and put into a day program and attended to by my regular civilian doctor where I was given the diagnosis "dysphoria" and "cyclothymia".
I was on Prozac and Xanax from 1993-1995 and thought I was doing fine until I burned out and felt very hyper and like I was going nuts. Then came Effexor for another 3 years with Xanax. I got pregnant in January of 1999 and I haven't been the same since. I have continual obsessive thoughts that race in my mind and don't make sense, I am extremely anxious all the time, I am moody and can't seem to find "peace", just being peaceful. I get very sad for no apparent reason. My mood can change at the drop of a hat in one day, or be good for several days. I get very hyper for a few hours and then crash on the couch from exhaustion. I get snappy. I look at knives and get scared I may hurt myself.
I feel like I am a hypochondriac when it comes to mental disorders. I am addicted to carbs, Pepsi, and cigarettes, I binge eat when I am upset or worried. Since the birth of my son in October 1999, I have been on Prozac, Lithium, Depakote, Paxil, Risperdal, Effexor, Wellbutrin, Luvox, Topamax, Klonopin, Neurontin, BuSpar, Zyprexa, etc. just to name a few.
Either I am sedated, extremely hyper and crying, or not getting anything. Currently I am on 150 mg. of Luvox, 800 mg. of Neurontin t.i.d., and Klonopin prn. I still obsess, am very anxious, my mind races, am moody, reactive, have bouts of deep sadness - especially where my mother is concerned - and obsess over mental illnesses. I have never cut myself, attempted suicide, used recreational drugs, or drunk alcohol. However, I have overspent, binge ate, gotten angry about my childhood etc.
I feel I do indeed have some of the borderline traits and my mother meets all of the borderline criteria to the max. She is an alcoholic and alcoholism runs rampant in the family. Nobody will give me a clear cut answer and I am more confused than ever. Cyclothymia, Dysthymia, Major Depression, Borderline, Narcissist, and Panic Disorder - those are all the varying labels I have had since I was a teenager. I was with one practice for 10 years, then another for 2 years and moved to a different city, and have been with this one since 1998.
I really don't know what to do, what to ask for from my therapists, whether to find a more qualified practice or what. I don't want to live the rest of my life like this. There has got to be a combination of medication and therapy that works for me. Would you please offer some insight? I would be so grateful.
Thank You.
ANSWER:
You very likely have the BPD, and according to what you wrote you've never been on
the best combination - Prozac with Tegretol. This combination is particularly effective
after you've been on the Prozac for a week first.
You need to find out what medically treatable diagnoses you actually have.
This FAQ
should help you enormously.
