QUESTION:

I'm in a very bad place right now. I'm 33 years old and was diagnosed about eight months ago. I have a husband and three children. My husband is fed up with me. I suddenly after having a stressful day with my son who is ADHD (Attention Deficit Hyperactive Disorder) and possibly bipolar, he's eight years old and has started Depakote about two weeks ago. Anyway I lost my temper and lashed out at my husband. Later that night when the kids were sleeping I had uncontrollable rage and became violent by throwing things and I smashed my head into the wall.

I'm currently on 600mg. of Neurontin three times a day, Buspar 15mg. two times a day and Wellbutrin 150 SR two times a day. Is it possible to need a change in my meds. Do you become immune to them after a while? Why when I was doing so good for about five months did I lose control?

DR. HELLER'S ANSWER:

First of all please understand I don't know all your diagnoses. Since ADD is genetic, there's a high chance you have it to and get impulsively angry.

I believe strongly that three parts are involved in treating the BPD successfully:

1. Treat all the chronic symptoms of all the disorders. In my experience it's extremely unusual for a person to do well without taking an SSRI, particularly Prozac. Buspar is for the generalized anxiety disorder, and once an individuals with the GAD has taken it for a while, SSRI's can usually be taken without side effects. Neurontin is helpful but can cause impulsive ADHD like behavior and I only use it for the BPD when a second epilepsy medication is needed besides Tegretol. Lamictil and Depakote are other options. Neurontin can be effective, however, it's just not consistent. It's major benefit appears to be treatment of chronic pain.
2. A formal treatment plan for stress. Stress induces a seizure like phenomenon of dysphoria - anxiety, rage, depression, despair, which can also included temporal lobe seizure symptoms such as deja vu and paranoia. It's due to malfunction in the dopamine system in the limbic system. The dysphoria instruction sheet I give my patients is in the "medications" section of this website. There are no chronic medications that will prevent crashing completely, so a formal plan to prevent it under stress and treat it quickly once it starts is crucial.
3. Brain retraining. You need to learn to like and love yourself, and act in a health manner. Counseling is usually required - but it's not the only thing.

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