Q. I was diagnosed with Borderline Personality Disorder about 3 years ago. After numerous attempts of using different medications (including Paxil, Zoloft, Wellbutrin, Klonopin, etc.) I am now on 25mg of Nortriptyline 3 times a day, and Lorazepam 1mg also 3x a day. Unfortunately I still experience severe “crashes” that come in cycles anywhere from 5 weeks to 10 days. The crashes usually last 2 to 4 days.
My question is: Is this a good medication for me to be on to actually help me? I’ve tried others but my problem is that I can’t really use myself as a “guinea pig” to try them and maintain a normal life with a job at the same time. My other question is how does a person with BPD keep and hold onto a job when these attacks completely immobilize me and make me incapable of working for the 2 to 4 days that these attacks last?
I am also currently uninsured and can’t afford the time to experiment in a trial and error way. Is there any advice you could give me both in medications and legal issues with employers? I also seem very sensitive to new drugs with past attempts landing me in the hospital with extremely severe crashes from finding out the hard way that the new meds DIDN’T WORK! Thank you for any advice and help you can give me.
A. You’ve never taken the best two medications for you: Prozac followed by Tegretol. People like you often respond very well to Prozac daily, and one week later beginning Tegretol. I usually start the first dose in the mid afternoon to see how dramatic an effect is present for chronic dysphoria (anxiety, rage, depression and despair). Folks “crashing” frequently usually can do well taking one 200mg Tegretol tab in the early evening without experiencing undo grogginess in the morning. It’s not simple, however. Haldol as needed for crashing is remarkably effective. Lorazepam is the best of the benzodiazepines, but I rarely use them for treating the BPD for many reasons – including legal and impairment.
One Prozac daily combined with generic Tegretol and occasional Haldol is manageable financially – and can keep you in one piece long enough do have some stability in your life.