QUESTION:

My 15 year old daughter was diagnosed with Major depression with psychosis in October. She tried to cut her wrist and my husband and I got some help for her the next day. Since this time she has been on 9 different drugs (SSRI's Neuroleptics and Wellbutrin) She has had very little relief from any of the drugs. She now has a permanent tic and started cutting her arms in November.

She hears voices and feels that someone is outside when she is alone and up at night. These "voices" are fleeting but scary. She has vivid suicide ideation still and feels empty and worthless. She is suffering greatly.

I would like to find some direction from someone about where to go and what to ask her doctor and therapist to do to get her diagnosis right. I really think that treatment for personality disorders and major depression might be different. I have finally battled with my HMO for a neurological exam at the Miami children's Hospital to rule out any physical problems. I wish that this was done first. Seems to make some sense to me.

Her therapist has just begun schema-focused Cognitive therapy. According to him she has 11 to work out! He has been wonderful and Nicole trusts him very much but there has to be something that might work to give her some relief a bit sooner than the years that it looks like this will take.

DR. HELLER'S ANSWER:

I certainly agree with the neurological exam, and Miami Children's is an excellent facility. I suspect they will find some temporal lobe dysfunction, possibly seizures.

Every effective treatment for the BPD also treats major depression.

Her symptoms are certainly consistent with the BPD. Auditory hallucinations (hearing voices) is rare, but occasionally does happen in borderlines experiencing dysphoria and other psychotic symptoms.

I would also recommend looking for the generalized anxiety disorder, particularly the cognitive component. This is often the cause of tics "developing" from medications, particularly SSRI's. If she does have the BPD the combination of Prozac followed a week later by Tegretol should be extremely helpful.

A week later after traveling 4 hours to see Dr Heller

Dear Doctor Heller,

Thank you so much for meeting with my daughter today. She started feeling much better on the drive home to Jupiter.

She had a group therapy session at 7PM and we met with her therapist prior to the group. He was very supportive and read some of your writings that I had downloaded. After the group session he came out and said that the session was great and that might want to share something funny with me. A member of the group felt very guilty about something that she had done and my daughter ended up giving her a "pep talk" about getting back on the "horse" and forgiving herself. She said that she could not believe that she was saying these things and also meaning them. Apparently the group and and therapist got a good laugh when they all said "*****...is that really you?" She laughed until she cried. Happy tears for a change!!!! She is also sleeping before me! This is so very unusual even with drugs that knock wild animals out!

She also wrote this today. She writes all of the time and most of her poetry is very dark...This is hopeful.

BROKEN

The sun rose,
And as the sunlight kisses my eyelids,
I find my mind.
Broken in many pieces like my heart,
shattered like my hope,
and torn like my soul.
I reach to the floor,
and though cutting myself on ragged edges,
The pieces are collected.
I brush away denial (almost)
My mind is back and no longer lost
Just...
Broken.

See you next week and thanks...

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