Annual Updates - Borderline Personality Annual Updates

Written by Dr. Leland Heller

ADD & ADHD:

1) Strattera is a non stimulant approved by the FDA for children, adolescents and adults with ADHD. It has the huge advantages of not being addicting, it can be phoned in, and it works 24 hours a day. It can work as effectively as the stimulants, but takes some time to work - usually weeks. Side effects primarily relate to grogginess and stomach upset, and urinary retention. The heart rate and pulse may go up by a small amount. Dose adjustments may be needed frequently. It's not uncommon for Strattera to be combined with a stimulant.

2) I am finding that for most adults Adderall gives the greatest benefit compared to Strattera and methylphenidate (Ritalin, Concerta and others).

Major Depression:

1) A study showed that antidepressants cause more brain cells and glial cells to grow.

2) If Prozac is not needed, I'm prescribing Lexapro in addition to Remeron, Effexor and Wellbutrin. It seems to be tolerated better than other SSRI medications.

Panic and Anxiety:

1) The epilepsy medication Neurontin (gabapentin) can be just as effective as benzodiazepines such as Xanax (alprazolam), Klonopin (clonazepam) and Ativan (lorazepam) for treating and preventing panic attacks. The dose range is wide - ranging from 100mg daily to 1800mg three times daily. Most patients need to start with a low dose and move up to a more effective dose. It's an expensive option, but it can be very useful - especially in alcoholics, those with the BPD, and substance abusers where benzodiazepines can be dangerous.

2002

Borderline Personality Disorder:

1) Abilify (aripiprazole), a new antipsychotic, can replace Risperdal (risperidone) for many borderlines experiencing severe dysphoria (anxiety, rage, depression and despair). 60% have no side effects, and when it works it generally works within 3 hours. Many get just as sedated as they do with Risperdal. In that case I prefer Risperdal because Risperdal always works, and Abilify (aripiprazole) doesn't always work.

2) In his wonderful new book "Where God Lives," Dr. Melvin Morse reports that many researchers, particularly at the University of California, San Diego, have discovered the part of the brain that is attached to God and the Universe. It's above the right temporal lobe in the Sylvian Fissure. When an individual with the BPD has a dysphoric spell, it's a seizure that temporarily cuts the person off from God and spirit. This is why the borderline can act antisocially when dysphoric and feel so much remorse afterwards.

3) The medical research has shown additional evidence of the medical nature of the BPD.

4) Prozac (fluoxetine) has been shown to improve the function of glial cells. 90% of the cells in your brain are support cells called glial cells, not neurons. I strongly suspect the BPD is largely due to glial cell malfunction. This may explain why Prozac is so much more effective than the other SSRI's in treating the BPD, such as Zoloft (sertraline) Paxil (paroxetine), Luvox, Celexa or Lexapro.

5) Effexor (venlavaxine) in high doses (450-600mg daily) can be helpful with the BPD, but I've never seen a patient who did better with Effexor than the Prozac/Tegretol (carbamazepine) combination.

ADD & ADHD:

1) The major change has been the addition of many long acting formulations that mean individuals don't have to take a mid-day dose.

2) Focalin, a "stereoisomer" of methylphenidate, is particularly useful for early evening stimulant use without causing insomnia.

3) While substance abuse has gone up enormously in our society, treating ADHD lowers substance use. The use of psychostimulants in children has gone up 800% in 10 years, but substance use is down 50%.

4) The combination of the antidepressant Remeron (mirtazapine) with a stimulant can counteract the appetite loss and insomnia.

5) Many strides have been accomplished proving the biological, and mostly genetic cause of ADHD. The study showing smaller frontal lobes in some ADHD individuals does NOT mean they are less intelligent. I have routinely found that those with ADHD are brilliant, clever and creative.