Q. You recommend Prozac plus Tegretol as the best treatment for borderline personality disorder.
I have been diagnosed with BPD, PTSD/dissociation and recurrent depression. I also have difficult-to-control seizures, caused by a childhood head injury.
I am currently taking Tegretol, Neurontin and Sabril, all prescribed for my epilepsy.
Several months ago, I was prescribed Prozac. I had an *extremely* bad reaction to this – a severe mixed state with psychosis (the first psychotic episode of my life).
Other antidepressants (including Aropax/Paxil) have triggered hypomania in me.
Given that I’m already on Tegretol, and can’t tolerate Prozac (and other antidepressants)– what would you recommend?
I strongly object to the “borderline” label, and don’t meet the full DSM-IV criteria for the disorder– but I certainly relate to your description of “chronic dysphoria”.
A. Interesting questions. I also don’t like the “borderline label.” If you chronically experience moodiness, chronic anger, emptiness, and boredom even doing things you enjoy the BPD diagnoses seems more likely. I’m obviously not your physician, and your physicians have had their hands full with your neurological problems.
Take a good look at the criteria for the Generalized Anxiety Disorder, particularly the “cognitive component” – SSRI’s often trigger worsening anxiety until the GAD is pretreated.
Secondly, it sounds like you are getting bipolar episodes (there’s actually a bipolar diagnosis for those who only get it when taking medication). There are some options. Depakote (valproic acid) is another seizure medication that works as well as lithium for the bipolar disorder.
A patient like you sometimes requires pretreatment with medications to prevent consequences. I am not your physician, and I do not know the details.
If I had a patient like you in my office, I would carefully explain what was wrong, explain the risks, and then if and only if the patient wants to try a different plan I would probably recommend that the following things be done: 1) check all the diagnoses – psychiatric and medical – and make a plan of treatment, 2) add depakote, 3) make certain all the epilepsy drugs that require blood monitoring are being monitored and in the upper half of normal, 4) add a good antipsychotic medication such as Risperdal or Zyprexa to prevent psychosis, and then 5) starting with an extremely low dose gradually begin Prozac. This approach will likely have lots of side effects – particularly grogginess, but after the depression and dysphoria were gone for a few months, the medications could slowly be reduced and some stopped.