QUESTION:

My girlfriend is taking Neurontin (2700mg/day), Prozac (40mg/day) and Depakote (1500/day). She is still experiencing significant depression and motivation problems. Since on this combo her rage episodes are significantly dulled and less frequent, and her depression is improved a little.

What else can be done to treat the depression?

I notice symptoms in her that seem to mimic ADD. I've also heard that Ritalin is given sometimes to severely depressed people. Do you think Ritalin would be appropriate here?

I also wonder about Dexedrine. Sometimes it too is given to ADD people. Don't know if it helps depression. Maybe it would help her motivation, and stop her binge eating. BTW she's gained 30lbs since she’s been on these drugs and pretty much stopped purging, but part of the depression may be due to her increased weight.

DR. HELLER'S ANSWER:

The first thing is to get all the diagnoses established - does she have ADD or the generalized anxiety disorder. Has her thyroid and B12 been checked - low thyroid can cause weight gain? Is her blood level of Depakote in the upper half of normal? Is she still experiencing chronic dysphoria - anxiety, rage, depression and despair? Is she experiencing dissociative symptoms such as deja vu, everything feeling unreal, or like she's looking out of someone else's eyes.

Neurontin has been documented to mimic ADHD in children, and it is possible that it's doing so in an adult. It's also possible that now that her BPD symptoms are better, ADD symptoms are becoming more obvious. The DSM IV has very specific criteria for the diagnoses.

I prescribe Neurontin and Depakote, but only when the person is intolerant or allergic to Tegretol or have bipolar, and occasionally they're not stabilized on medications and need dysphoria assistance.

Ritalin seems to "unmask" depression in children, and is great for depression in the elderly. It does not seem to help depression in younger adults. Dexedrine is inappropriate for weight loss purposes.

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