QUESTION:

Hi Dr. Heller,

My daughter is 20 and currently in the state mental hospital. She has recently been diagnosed with depression with psychotic features and borderline personality disorder. They have her on 1000mg. Depakote and 30 mg. Paxil.

She is like a zombie and they just keep telling her to “relearn new skills”. She can’t function and sleeps most of the day. She then misses out on her groups and then loses her privileges. She has had many different diagnoses throughout her life, from ADHD to Bi-Polar. Do you think this med. combo is the wrong one and how long should the Dr. wait before changing it?

Thank You.

 

ANSWER:

If she is “like a zombie” and not doing well, the medication regimen isn’t a good one. Blood levels of medications are far more important than the actual dose. I consider Depakote and Paxil secondary medications for the BPD.  They can be effective, but they’re not the best for most patients.

The most important issue here is what exactly her diagnoses are. I doubt if only one diagnosis is present. There are a number of diagnoses that need to be addressed. BPD, bipolar, and ADHD are just a few. The screening test, official criteria, and “Is it bipolar, BPD or ADHD” will undoubtedly be useful to you.

I can’t understate the importance of making all the diagnoses. The generalized anxiety disorder is particularly important. I have a few adolescents who are extraordinarily difficult to manage, and my heart goes out to you, the child, and the dedicated people trying desperately to succeed with her. I encourage you to get as much information as you can.

 

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