BPD and Generalized Anxiety Disorder

Written by Dr. Leland Heller

QUESTION:

I was diagnosed with BPD and GAD (Generalized Anxiety Disorder) quite a few years ago. Prozac, Paxil, and Zoloft made me feel worse. I had a good response to Nardil and have taken it for 5 years. I have tried to go off of it several times with no luck. I just have to accept being on it for now because I must stay stable. I also take Klonopin. I am very rejection-sensitive (possibly from my father dying when I was 3) and quite social phobic.

I'm not at all inwardly motivated, I feel overwhelmingly sad and lonely at times, and I get these scared anxious feelings when I think about things like finances, the future, my son, etc... I obsess and worry a lot. These are the types of symptoms I do battle with each day. My insomnia has worsened. I don't feel rageful and I've never cut or injured myself.

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Recently I've started to attend church to better my life and feel less isolated. I've been reading self-help books and saying positive messages to myself several times a day. My therapist and I are finally going to start meeting weekly. Before that we met only once a month to check on the medication changes.

Here are my questions:

1. What type of therapy do you find most effective?
2. How much Inositol is recommended for GAD and OCD? Are their other vitamins or supplements that can help?
3. I've been taking Ambien off and on for insomnia and it really helps. Is this a sleep medication that should be used only sometimes. The insomnia is caused by the Nardil. Would Nardil aggravate or help GAD?
4. Is taking Nardil and Buspar together contraindicated?
5. Finally, does Trazodone correct the serotonin malfunction in GAD like Buspar, or does it just help by being sedative?

I apologize for the length. I've written to you before and know that you don't use Nardil with your patients. My doctor has never used it and knows nothing about it . He leaves it up to me to get any information I need. It makes me feel sort-of out on a limb by myself.

I'm really trying to heal my brain these days so any information would be appreciated.

Can't wait to read your book!

DR. HELLER'S ANSWER:

1. You need medications! Then therapy can do wonders. I'm not a therapist so I'm not qualified to make a recommendation in that regard.
2. Inositol is for OCD only, it will not affect the GAD. The dose according to the Israeli study was 6000mg three times daily.
3. I'm not a Nardil fan, too dangerous, too many drug interactions for my practice. It's not wrong in the right patient, however.
4. I believe Nardil and Buspar together would be contraindicated.
5. No, Trazodone doesn't do that.

You are out of balance. Some serotonin levels are too high, some are too low. Buspar initially raises them - causing some side effects, then lowers the high ones. Once they're lowered SSRI medications like Prozac can be added. Another option is Effexor in high doses. I've never seen anyone happy or do great without major side effects, however. On some of my patients with panic, GAD and BPD who are intolerant to the usual medications I'm trying Effexor for a month first, then adding in Prozac. Will see what happens. Effexor has now been FDA approved for the GAD.

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