Dissociation and cutting
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Dissociation and cutting --

Q: I wrote to you in October, and you gave me some great advice. I'm now on topamax (100mgs/day and going up) and 6mg of klonopin. I try to exercise more, but really haven't been able to regulate my sleep, which probably worsens my cycling. Two big things which I neglected to tell you (and my new shrink)- I am using hydrocodone (Norco) at about 100mg/day. I am not getting high- it really keeps me calm. But I am dissociating and cutting again- things I haven't done since I was a teenager- 15 years ago. Is this depression or possibly drug(s)? I am really ashamed of this and writing is a lot easier than talking about it. Do you have any thoughts? I don't feel suicidal- I don't even know I am doing it, but I had to have stitches yesterday, so I guess I have to deal with it. Thank you for any input- Judy

Dear Judy -
Sometimes mood stabilizers help to keep people from dissociating, as you clearly are now.  So just moving the Topiramate up may help (don't go too fast though: wow, does it mess some people up.  They can't think straight even when they are aware of what they're doing!).

Adding other mood stabilizers at low doses might help.  Several my patients have found that naltrexone stops their self-harm behavior.  What's naltrexone?  It's an opiate-receptor blocker.  So for one thing, you'd have to stop the hydrocodone to even try it (if you didn't get off that completely first, the naltrexone would cause you to have a sudden opiate withdrawal, like what heroin users go through.  You don't want that...).  It's also used to help people with alcohol problems: makes 'em drink less often, and drink less when they do drink (about 50% less of each, in fact).  Why this naltrexone also seems to limit or stop self-harm behavior is not known -- it may have something to do with one's own opiate receptors, which might somehow relate to why taking hydrocodone seems to help.

In general I'd hold out hope that by increasing mood stabilizers you'll be able to lower and finally stop the hydrocodone -- and then maybe try naltrexone.

Dr. Phelps

Published November, 2000

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