BPD and Serotonin Syndrome

Written by Dr. Leland Heller

QUESTION:

I have been through all of it and my sanity (if there is any left) is on the brink. In addition to Prozac(80to100mg), Elavil(100mgs) and sometimes Klonopin(2mg.), my psychiatrist just put me on Lamictal(50 mgs to start. I am a chronic cutter and getting worse all the time. I actually cut through to vein the last time. What really scared me was that later, I actually became fascinated with the whole thing. Sick, huh? I cut as a young teenager and stopped for many years. I started taking antidepressants when I was approximately 32 years old. I stopped for a while each time I got pregnant (x2) then went back on it. So, I've been on them for about five years now.

I had back surgery in March,1998. By the end of May, of the same year, I went into a deep depression and spent six weeks in a hospital. By the end of the first week, the Dr. in charge prescribed 120 of Prozac a day ( along with other drugs of which I don't remember). I turned into a mindless blob. My insurance company did not agree with the course of treatment that I was receiving. After three weeks, I was transferred to another hospital only to receive different drugs and many ECT treatments . Of course at that point I didn't or couldn't really see or feel what was happening. The most interesting thing occurred during the second or third week in the first hospital.

I began this cutting thing again. And, as I said before, it's only getting worse. I have been hospitalized three more times since then. I started educating my psychiatrist with regards to people who cut and where there are treatment centers (nothing by me) and at least he has stopped the emergency room from committing me, to treat my wounds and let me go home. MY QUESTION to you is about "Serotonin Syndrome". I read an article in today's health section in the newspaper. There was a question posed to the Dr. who writes the column about the use and toxicity of serotonin. He answered that he knew of a patient who suffered from this syndrome. Of course, I then jumped on the computer to do my own research. Well needless to say, whether psychological or not I have a lot of related symptoms. Increased headaches, constant hand tremors, nausea, blurred vision (I know this could be my age but it came on suddenly and has gotten worse). I just received a new rx. four months ago. And, just since last week and before I even researched the syndrome, my muscles began twitching all over, and my right foot is numb etc.ect.

OK MY POINT IS.....that we are all puzzled about my behavior, why I began cutting again after all these years. I get agitated and can't hold a thought in my head for much more than a few minutes at a time. I know that all of these things could be just side effects caused by the drugs but... I also read that "Serotonin Syndrome" can be fatal.

I know that I feel suicidal almost daily and, that maybe I shouldn't care about the fatality of something, but I don't want to be hooked up to machines to live either.

Please let me know if you've heard of this. Outside of the internet and today's newspaper it has never been mentioned. And, of course the drug companies information doesn't say a word. Should I bring this up to my own Dr. and chance being humiliated or is there a possibility that he wouldn't know to much about it(as he didn't about the cutting?

DR. HELLER'S ANSWER:

I recently attended a neurology lecture on headaches where this topic was brought up. The expert stated that "serotonin syndrome is usually only a problem when drugs like Elavil are combined with high doses of an SSRI like Prozac." A study by Dr. Paul Soloff last in the 1980's showed Elavil caused borderlines to become paranoid, assaultive and suicidal.

I suspect you'll be stunned by what Tegretol can do for you when added to Prozac even if you only use it when your urge to cut is strong. I know the medical regimen I write about works as I've seen it work thousands of times. Tegretol is not expensive, nor as risky as Lamictil - which is usually an add-on antiepileptic medication.

The reason you cut is for one simple reason - it works! It works to stop your incredible dysphoria - anxiety, rage, depression and despair. Borderlines participate in their self destructive behaviors to stop their pain, and the pain is very impressive. For some reason self-mutilation causes a neurochemical change that temporarily stops the dysphoria.

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