Q. I am a textbook Borderline and have been forever. I also chronically self-mutilate and have had a very bad childhood filled with abuse. At the age of 18 I was placed on Tegretol. I was not cured by any means but did show marked improvement in stability of my moods. As the years went on I went off and on Tegretol staying on it only a few months at a time until I showed improvement.
The last two times I tried getting on it I broke out in hives and had to stop taking it. I seemed to have become allergic to it. Is this known to happen with Tegretol? I have spent many years in some form of treatment or another and have tried many many different medications, including Prozac. I have found that Tegretol was the only medication that offered help. I have tried other seizure meds, anti-psychotics, anti-depressants, etc. None made so much as a dent. Do you have an understanding as to why I became allergic to Tegretol?
A. It’s such a problem when patients develop allergies to important medications. It just happens. There are many theories, but none have anything to do with you or the BPD. Hives must be taken very, very seriously.
A mistake patients commonly make is assuming a certain medication won’t work. It’s often the sequence, the dose, or the combination.
I’m not your physician, I don’t know you, and I don’t know all your diagnoses. I can make some suggestions that I often try on my patients with similar problems. First is Prozac, usually 20-40mg daily. After a week depakote can be tried – chances are you’ll have good results. Often the combination of depakote and Neurontin can help. It’s the combination you likely need, not just a specific medication. Timing is very important. If you haven’t been on Prozac for a week first before trying depakote and/or Neurontin you don’t know whether it will work or not.
Lamictil is potentially more dangerous but has helped a few patients dramatically – one a self mutilating borderline. The risks and benefits of inadequately treating self mutilation (which can lead to suicidal behavior) likely outweigh the risks. Discuss this with your doctor.
Treating everything else that’s wrong could be far more important as well.