QUESTION:

Dear Dr. Heller:

I have been diagnosed with Borderline Personality Disorder and am anxious to get onto the right meds to help me. But I have an immediate problem: I have been taking 50 mgs. of Trazodone for 4 years now. It is very uncomfortable each time I try to get off it even by reducing as little as half a dose at night. I get anxious and feel disoriented the next day and those bad feelings increase with each new day without the full dose.

I get an overwhelming rush of tension and anxiety if I try to take the Prozac on top of the Trazodone. But I had success with Prozac 8 years ago when I had no other antidepressant already present in my bloodstream. So my dilemma and question to you: (My doctor has no advice he said just quit, and I could not function cold turkey). So, knowing I have to get off of Trazodone slowly, can you recommend - How slowly should I reduce off of the 50 mg. a night to avoid the anxiety, disorientation, hang over type feeling?

Would the BuSpar you mention help if I began taking it now while trying to get off the Trazodone? One of the first withdrawal effects of not taking Trazodone is restlessness at night disrupting quality sleep. My goal is to get on the Prozac BuSpar combination you highly recommend. Thank you very very much for answering this question.

DR. HELLER'S ANSWER:

There is usually no reason to stop taking the trazodone until you are doing well. Trazodone is commonly used for sleep problems due to SSRI medications like Prozac. If the GAD is present, BuSpar should be used with the trazodone until you can take Prozac without a problem. At that time the trazodone can be stopped if necessary. Another option is the temporary use of a benzodiazepine at night only to help with sleep while you quit the trazodone and go onto Prozac. My screening test will likely be of great help to you.

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