Q. I am a 35 year old woman who has been on medication for major depression and bpd for 8 years. I’ve also been diagnosed with PTSD, generalized anxiety, avoidant personality disorder, antisocial personality disorder, and bulimia. In addition, I have several medical problems, including polycystic ovarian disease, asthma, hypertension, diabetes, morbid obesity, and fibromyalgia.
I actually have four questions.
#1 I was being treated for the polycystic ovarian disease with birth control and dexamethasone. Although it lessened my symptoms, it was not completely successful. QUESTION: Is there a relationship between dexamethasone and depression?
A. Maybe. Steroid use can cause psychosis and depression. There was a blood test called the “dexamethasone suppression test” which was supposed to help diagnose depression – it was useless. Under stress we produce too much of a steroid called “cortisol” – which over time likely does indeed worsen depression.
Q. #2. I read in your discussion that treating BPD with Elavil makes it worse, I was taking Elavil for treatment of fibromyalgia and was wondering if you could recommend something as an alternative?
A. Fibromyalgia in my opinion is a combination of muscle spasm, irritated nerves in the muscles, and the resulting anxiety and depression that go with it. Posture is of immense importance, and many times a posture support is necessary. The psych problems can cause it as well. There are many alternatives for pain, you need to ask someone who manages pain, but research at a major psych hospital in the mid 1980’s revealed Elavil causes increased paranoia, assaultive and destructive behavior in patients with the BPD.
Q. #3 What tests, if any, do I need to insist on when I see the doctor, to get him to put me back on Synthroid? I was taking it for a couple years, but when they tested me a couple months ago, my tests were normal and so they took me off. I know my thyroid is underactive, I starve myself and do not lose weight. my fingernails are brittle, my hair is falling out.
A. If the blood tests are normal, you may have “non primary” hypothyroidism (secondary or tertiary). If your doctor won’t treat it you may need to see an endocrinologist to either treat it or investigate the possibilities of secondary or tertiary hypothyroidism.
Q. #4 Does treating bpd with Prozac plus Tegretol control the rage? I have been on 80 mg prozac and 20 mg Elavil for several years, (as well as the dexamethasone and Synthroid) and although I was able to maintain most of the time, I was miserable and depressed and very self injurious. I was able to control the rage by directing it unto myself. Would Tegretol help me with the rage?
A. It can markedly reduce it, but not completely eliminate the rage. I advocate the use of an as needed neuroleptic like Haldol when anger begins to stop it. Borderlines are allergic to anger. Rage and self injurious behaviors must always be stopped.