HOW CAN YOU TREAT BPD WITH BIPOLAR? 
Ask The Doctor Dr. Leland Heller Biological Unhappiness 
HOW CAN YOU TREAT BPD WITH BIPOLAR? 
Question: Hello, I have been diagnosed with borderline personality disorder three years ago and recently I have been diagnosed with bipolar. Is this common? How does one cope with such? Thanks Dr. Heller’s Answer: In my experience its far more common for individuals with bipolar to have the BPD than those with BPD to have bipolar. Either way its not unusual, nor is it that difficult to treat. Its just more complicated. The two main problems are: 1) that Prozac (fluoxetine) can trigger a manic episode and 2) that while Risperdal always pulls an individual taking Prozac out of a BPD dysphoria spell in 24 hours, it doesnt pull an individual out of a bipolar depression spell like that. With rare exception three days of Zyprexa 10mg at night are needed. Since BPD dysphoria is far more common than bipolar depression episodes, I usually treat them first. Tegretol is an excellent bipolar medication as well as an excellent BPD medication. When I start BPD treatment complicated by bipolar, Ill usually start Prozac combined with Zyprexa for 6 days and then add the Tegretol. Everything else stays the same including the dysphoria instruction sheet, with the exception of the paragraph above. http://pks.947.myftpupload.com/dysphori.htm Another complication is that those with the BPD frequently also have ADHD, and stimulants can trigger mania. Most patients can tolerate stimulants if they are also on mood stabilizers like Tegretol, however. 
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