QUESTION:

My son is on many medications for bpd. He also had viral meningitis over 4 years ago. a cat scan revealed right temporal lobe damage which could have been caused by the infection. the medications he is on are helping somewhat except that he still feels much depression and anxiety. Also has gained over 80 lbs. they are: Paxil 80mgs, Remeron 30mgs, Neurontin1200mgs, Seroquel 300 mgs, and Adderal 30mgs. He was taken off Zyprexa because of the weight gain, and they are going to change the Paxil to Effexor to help with the dysphoria. Is he on too many meds? What side effects should we worry about. He is not able to lose the weight gain. Please feel free to give me your recommendation on the meds so that we can go forward with therapy.

DR. HELLER'S ANSWER:

First of all he needs all his diagnoses made. If he has the generalized anxiety disorder, Buspar will usually be necessary. I usually prefer Tegretol to Neurontin, using Neurontin as a second medication and for those who are intolerant to Tegretol. He probably has temporal lobe epilepsy and may need two seizure medications, such as Depakote, Neurontin or Lamictil. Neurontin can cause an ADHD like syndrome.

I also generally try to avoid the chronic use of antipsychotic medications like Seroquel, although sometimes it's necessary. Zyprexa is notorious for phenomenal weight gain, and Seroquel may be contributing to his inability to lose weight - but it's not as clear cut as Zyprexa is.

Either Adderall or Ritalin is good for attention deficit disorder, although the research supports the use of robust doses, not low ones. Cylert usually causes dysphoria to worsen.

I prescribe Paxil for Panic Disorder, but in my experience Prozac is much better. There is a combination of panic, GAD, BPD with Chronic Dysphoria and carbohydrate cravings that seems to have it's own neurological base. I'm finally finding some success by combining low doses of Effexor (37.5-75mg) for a few weeks, then adding Remeron 30mg daily. A few weeks later Prozac can usually be added without problems. Sequencing, dosing and timing of medications is often as important as the actual medications.

He should get his thyroid and B12 levels checked. He will likely need nutritional education, exercise and feeling better emotionally to do better. As with everyone else he needs all his diagnoses made. He also needs his self-esteem and hope worked on. Listening to Zig Ziglar would be an excellent idea as well.

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