QUESTION:

I have been diagnosed with BPD, PTSD and GAD. I have been treated with SSRI's which cause increased irritability and poor rage impulse control. After taking your screening test, I see I also have untreated ADD. (My son was diagnosed with ADHD as a child.)

I had one psychotic episode at age 16 where I believed I was characters in different famous childhood stories, like Snow White. I was severely abused as a child. (I'm now 44.) I had symptoms of derealization as a child. I've had persistent problems with paranoia (thinking that people are talking about me) and social anxiety. For the last few months I have not been able to sleep through the night, waking up 4 - 5 times and laying awake for 1 - 2 hours each time (I stay in bed over 12 hours in order to get 5-6 hours of sleep.)

I am taking a very small dose of Lexapro now, 5 mg, which has caused me to start losing my temper. My doctor has suggested Abilify. What do you suggest?

Thank you very much, Dr. Heller.

DR. HELLER'S ANSWER:

Lexapro will also make you worse. The key medication is BuSpar (buspirone). For most people with the GAD and BPD, two weeks of BuSpar first will allow you to take SSRI medications like Prozac and Lexapro without them making you worse.

Remeron (mirtazapine) could help you sleep well and protect against BuSpar making the PTSD worse. In situations like yours I usually continue to prescribe Remeron for 6-8 weeks and then stop it as long as Prozac (fluoxetine) is also being taken.

You may need to take Tegretol (carbamazepine) for a while, particularly at night. I usually wait until the patient is on Prozac (fluoxetine) for a week first.

Of all the atypical antipsychotics, Abilify is the one I prescribe most for continuous use. It seems to cause the least weight gain. Most individuals with BPD don't need chronic treatment with atypical antipsychotics like Abilify, Zyprexa, Risperdal, Seroquel, etc.

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