QUESTION:

Dear Dr. Heller,

I was diagnosed with BPD many years ago and responded well to Prozac. I was on it for about fourteen years but for the last few years found it made me very sleepy and lethargic. Taking it at night helped but I was still very tired and lethargic the next day. I also have hypothyroidism but this is now controlled with medication, yet taking just one Prozac at night even on the thyroid medication still makes me tired. I find Prozac also effects my memory especially my verbal and linguistic skills and as I am a writer this is a debilitating side effect. After months off Prozac my energy levels increased and so did my writing skills, so it couldn't have been my imagination. Yet off the medication I went back to the old symptoms of dysphoria, mood swings, suicidal thoughts, self-hate, sudden uncontrollable anger etc. etc. Can you suggest an alternative medication? I was treated very successfully by a psychiatrist here (in South Africa) but he has now emigrated to Australia and our GP doesn't really know a lot about BPD.

Thanks.

DR. HELLER'S ANSWER:

There are three possible explanations:
1) You have the generalized anxiety disorder that is worsened by Prozac, and with increased stress the anxiety disorder has worsened. BuSpar is the appropriate medication to add here.
2) You have developed chronic dysphoria (anxiety, rage, depression and despair) with or without the generalized anxiety disorder. This would respond to the addition of Tegretol to Prozac.
3) Some individuals get a relative imbalance of serotonin with noradrenaline (and somewhat with dopamine). This imbalance can cause fatigue and a lack of zest for life. The addition of Wellbutrin would stop this side effect, and can improve the difficulty achieving orgasms that SSRI's like Prozac can cause.

Unless unprovoked mood swings, anger problems, emptiness and boredom and depression are completely gone, I believe those with the BPD should stay on Prozac.

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