QUESTION:

I have BPD and am extremely sensitive to medications. I am currently on 20 mgs of Celexa but find after three months it is no longer helping me and I sleep on average 14 days. I have tried all other SSRI's and have the same reaction to every one of them, they help for a while then stop and when I try to increase them I become so extremely tired I cannot function. This lethargy and tiredness is accompanied by restlessness and agitation. Although I feel I cannot keep my eyes open, my feet will be nervously twitching. I have tried Effexor which increased agitation, Wellbutrin which increased anxiety and Depakote which made me cry all the time.

I am very concerned about trying Tegretol with it's risk for suppressed bone marrow. I also wondered what you thought of this potential side-effect. I have found doctors to take these things very lightly and always respond with, "Don't worry we will monitor you closely.." Or, "that's very rare..."

I am concerned about what goes into my body and how it will affect me. I find that doctors are so willing to push medication but unwilling to consider the potential harm of these drugs which for the most part are all relatively new and little is known about them long term. I don't mean to put doctors down but after all they aren't the ones having to take all this stuff or suffer the side-effects. I am very depressed and feeling quite hopeless about any medications helping me at this point. I know you aren't my doctor but would appreciate any comments on these subjects. I do have a psychiatrist, he was unwilling to change my Celexa and I fear he doesn't know where to go from here.

DR. HELLER'S ANSWER:

Life is a series of risk vs benefits decision. Driving an automobile is a good example - it's very risky every time you get into a car, yet the benefits outweigh the risks. The physicians are correct about the Tegretol - lab tests do effectively monitor for the serious side effects.

Your condition is very toxic to your body. Neurotransmitters have receptor sites throughout the body, especially the immune system. Being so depressed causes enormous damage to your body.

With rare exception, in my experience people like you have anxiety based problems that complicate the picture. The generalized anxiety disorder is often present, particularly the cognitive component. It amounts to an imbalance in serotonin - too high in some areas, too low in others. Since many medications increase serotonin, the high ones get even higher. When this is the case, Buspar can work miracles although some patients have to use low doses and go up slowly as it temporarily raises serotonin also. Buspar is one of the safest medications available.

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