QUESTION:

I am bipolar and have BPD. I get severe dysphoric episodes, usually in the evening. I am a self injurer and the dysphoria usually drives me to cut, often very badly. I was put on Ativan for panic attacks and to control the dysphoria. It worked well, but I began abusing it. Now they won't prescribe me any benzo (I don't blame them). I need a drug that acts very quickly and slows me down but doesn't put me to sleep. I've been on Risperdal for the cutting, (it made me cut even more so they took me off it after 6 weeks) Seroquel for sleep (it made me feel drugged and horrible, even at a very low dose) Fluanxol for depersonalization (it worked but the injections hurt) Zyprexa (didn't work and I gained lots of weight) Nozinan for sleep (it doesn't work very well and an increase in dose makes me feel drugged and have a stuffy nose) and Loxapine (makes me feel angry and agitated). I have also been on Celexa (drove me into a manic state) Effexor (did nothing till I tried to get off of it and made then I got sick) and Lamictal (at a high dose made me agitated)I have difficulty swallowing pills, so whatever drug I have to take needs to be a small shape or liquid form. I am very anti drug, and at this time do not want to be on a medication daily, I'd like something I can take PRN. Would Haldol be the answer? Would it be difficult to convince my psychiatrist to let me try it? I've heard it's a very strong drug.

DR. HELLER'S ANSWER:

Haldol isn't any stronger than Risperdal, Seroquel or Zyprexa. When a BPD patient is successfully treated chronically with Prozac (and commonly Tegretol) Haldol usually works within 10 minutes with no side effects for the vast majority. I only prescribe it for prn (as needed) use. There were studies in the 1980's that showed its effectiveness, although it hasn't been studied for as needed use. It's a terrific medication for the uses you described in your question.

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