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Author Topic: TREATMENT: Medications  (Read 6996 times)
Skippy
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« on: July 12, 2006, 08:20:39 AM »

National Institute of Mental Health

A brief overview that focuses on the symptoms, treatments, and research findings. (2001).


www.wwwapps.nimh.nih.gov/health/publications/borderline-personality-disorder.shtml

Borderline personality disorder (BPD) is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior.

Treatment

Treatments for BPD have improved in recent years. Group and individual psychotherapy are at least partially effective for many patients. Within the past 15 years, a new psychosocial treatment termed dialectical behavior therapy (DBT) was developed specifically to treat BPD, and this technique has looked promising in treatment studies.6 Pharmacological treatments are often prescribed based on specific target symptoms shown by the individual patient. Antidepressant drugs and mood stabilizers may be helpful for depressed and/or labile mood. Antipsychotic drugs may also be used when there are distortions in thinking.7

Recent Research Findings

Although the cause of BPD is unknown, both environmental and genetic factors are thought to play a role in predisposing patients to BPD symptoms and traits. Studies show that many, but not all individuals with BPD report a history of abuse, neglect, or separation as young children.8 Forty to 71 percent of BPD patients report having been sexually abused, usually by a non-caregiver.9 Researchers believe that BPD results from a combination of individual vulnerability to environmental stress, neglect or abuse as young children, and a series of events that trigger the onset of the disorder as young adults. Adults with BPD are also considerably more likely to be the victim of violence, including rape and other crimes. This may result from both harmful environments as well as impulsivity and poor judgement in choosing partners and lifestyles.

NIMH-funded neuroscience research is revealing brain mechanisms underlying the impulsivity, mood instability, aggression, anger, and negative emotion seen in BPD. Studies suggest that people predisposed to impulsive aggression have impaired regulation of the neural circuits that modulate emotion.10 The amygdala, a small almond-shaped structure deep inside the brain, is an important component of the circuit that regulates negative emotion. In response to signals from other brain centers indicating a perceived threat, it marshals fear and arousal. This might be more pronounced under the influence of drugs like alcohol, or stress. Areas in the front of the brain (pre-frontal area) act to dampen the activity of this circuit. Recent brain imaging studies show that individual differences in the ability to activate regions of the prefrontal cerebral cortex thought to be involved in inhibitory activity predict the ability to suppress negative emotion.11

Serotonin, norepinephrine and acetylcholine are among the chemical messengers in these circuits that play a role in the regulation of emotions, including sadness, anger, anxiety, and irritability. Drugs that enhance brain serotonin function may improve emotional symptoms in BPD. Likewise, mood-stabilizing drugs that are known to enhance the activity of GABA, the brain's major inhibitory neurotransmitter, may help people who experience BPD-like mood swings. Such brain-based vulnerabilities can be managed with help from behavioral interventions and medications, much like people manage susceptibility to diabetes or high blood pressure.7

References

1Swartz M, Blazer D, George L, Winfield I. Estimating the prevalence of borderline personality disorder in the community. Journal of Personality Disorders, 1990; 4(3): 257-72.

2Soloff PH, Lis JA, Kelly T, Cornelius J, Ulrich R. Self-mutilation and suicidal behavior in borderline personality disorder. Journal of Personality Disorders, 1994; 8(4): 257-67.

3Gardner DL, Cowdry RW. Suicidal and parasuicidal behavior in borderline personality disorder. Psychiatric Clinics of North America, 1985; 8(2): 389-403.

4Zanarini MC, Frankenburg FR. Treatment histories of borderline inpatients. Comprehensive Psychiatry, in press.

5Zanarini MC, Frankenburg FR, DeLuca CJ, Hennen J, Khera GS, Gunderson JG. The pain of being borderline: dysphoric states specific to borderline personality disorder. Harvard Review of Psychiatry, 1998; 6(4): 201-7.

6Koerner K, Linehan MM. Research on dialectical behavior therapy for patients with borderline personality disorder. Psychiatric Clinics of North America, 2000; 23(1): 151-67.

7Siever LJ, Koenigsberg HW. The frustrating no-mans-land of borderline personality disorder. Cerebrum, The Dana Forum on Brain Science, 2000; 2(4).

8Zanarini MC, Frankenburg. Pathways to the development of borderline personality disorder. Journal of Personality Disorders, 1997; 11(1): 93-104.

9Zanarini MC. Childhood experiences associated with the development of borderline personality disorder. Psychiatric Clinics of North America, 2000; 23(1): 89-101.

10Davidson RJ, Jackson DC, Kalin NH. Emotion, plasticity, context and regulation: perspectives from affective neuroscience. Psychological Bulletin, 2000; 126(6): 873-89.

11Davidson RJ, Putnam KM, Larson CL. Dysfunction in the neural circuitry of emotion regulation - a possible prelude to violence. Science, 2000; 289(5479): 591-4.
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Skippy
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« Reply #1 on: July 12, 2006, 09:06:49 AM »

Medications Studied and Used in the Treatment of Borderline Disorder+

Robert O. Fiedel, MD


www.BPDdemystified.com/index.asp?id=21#2

Three classes of medications have been found to be useful in reducing the core symptoms of borderline disorder:

    * Neuroleptics and atypical antipsychotic agents

    * Certain antidepressants

    * Mood-stabilizing agents

Antipsychotics

   

Neuroleptics Symptoms Improved by One or More Medications in the Class - anxiety, obsessive-compulsivity, depression, suicide attempts, hostility, impulsivity, self-injury/assaultiveness, illusions, paranoid thinking, psychoticism, poor general functioning

   

  • thiothixene (Navane)*


  • haloperidol (Haldol)*


  • trifluoperazine (Stelazine)*


  • flupenthixol*


Atypica  Symptoms Improved by One or More Medications in the Class - anxiety, anger/hostility, paranoid thinking, self-injury, impulsive aggression, interpersonal sensitivity, low mood and aggression.

  • olanzapine (Zyprexa)*


  • aripiprazole (Abilify)*


  • risperidone (Risperdal)°


  • clozapine (Clozaril)°


  • quetiapine (Seroquel)°


   

Antidepressants

SSRIs and related antidepressants   Symptoms Improved by One or More Medications in the Class - anxiety, depression, mood swings, impulsivity, anger/hostility, self-injury, impulsive-aggression, poor general functioning

  • fluoxetine (Prozac)*


  • fluvoxamine (Luvox)*


  • sertraline (Zoloft)°


  • venlafaxine (Effexor)°


MAOIs  Symptoms Improved by One or More Medications in the Class - depression, anger/hostility, mood swings, rejection sensitivity, impulsivity

  • phenelzine (Nardil)*


Mood Stabilizers   Symptoms Improved by One or More Medications in the Class - unstable mood, anxiety, depression, anger,

irritability, impulsivity, aggression, suicidality, poor general functioning

  • divalproex (Depakote)*


  • lamotrigine (Lamictal)*


  • topiramate (Topamax)*


  • carbamazepine (Tegretol)°


  • lithium°





Neuroleptics and Atypical Antipsychotic Agents


The group of medications that has been studied most often for the treatment of patients with borderline disorder are antipsychotic agents (neuroleptics and atypical antipsychotics). Neuroleptics were the first generation of medications used to treat very serious mental illnesses, especially bipolar disorder and schizophrenia. The atypical antipsychotics are the second generation of medications developed to treat these disorders. When precribed in lower doses than ususal, these agents have been found to be quite useful in the treatment of many patients with borderline disorder. In my clinical experience, this is the most effective class of medications for the disorder, and the most rational starting point for pharmacotherapy. But is there any scientific data to support this contention?

In 2001, the American Psychiatric Association published a Practice Guideline for the Treatment of Patients with Borderline Personality Disorder. 3 Based on research available at the time, low doses of antipsychotic agents were recommended for patients with borderline disorder with symptoms of severely impaired thinking and behavioral control, anger, hostility, assault and self-injury. Research reported since 2001 has supported the findings that these medications appear to be effective in decreasing these and other symptoms of the disorder2 . They reduce over reactive emotional responses such as anger and anxiety, decrease impulsivity, improve the ability to think and reason, and enhance relationships. All but one published placebo-controlled study of antipsychotic agents in patients with borderline disorder have shown positive results. In these and in other studies,  medications in this class found to be useful in borderline disorder include the neuroleptics thiothixene (Navane), trifluoperazine (Stelazine), and flupenthixol, and the atypical antipsychotics aripiprazole (Abilify), olanzapine (Zyprexa),  and risperidone (Risperdal). Medications studied and used in the treatment of Borderline Personality Disorder.

Some patients are concerned about taking a medication that is typically used for people with  severe mental illnesses. Also, some physicians are reluctant to prescribe, and some patients are reluctant to take this class of medications because of a specific side effect that antipsychotics may produce called tardive dyskinesia. It is an abnormal, involuntary movement disorder that typically occurs in patients receiving average to large doses of neuroleptics.

To the best of my knowledge, there is no scientific evidence that indicates low doses of neuroleptics cause tardive dyskinesia in patients with borderline disorder. Nonetheless, although the risk appears to be very small, it should be noted. The atypical antipsychotic agents appear to carry a lower risk of causing tardive dyskinesia than neuroleptics when prescribed at the usual doses for patients with  severe mental illnesses. Therefore, these newer medications are now probably more commonly prescribed for patients with borderline disorder than are the neuroleptics.

Atypical antipsychotics and traditional neuroleptics may both produce side effects, some more than others. These include weight gain, headache, drowsiness, insomnia, breast engorgement and discomfort, lactation, and restlessness. Some of these, and other side effects, are temporary, and others may be persistent. Before you start on any antipsychotic agent, or any medication for borderline disorder, you should review its side effect profile with your psychiatrist.

Antidepressants

The second group of drugs studied for the treatment of the symptoms of borderline disorder are the antidepressants. Medications Studied and Used in the Treatment of Borderline Personality Disorder.



SSRIs and Related Antidepressants


In the APA Practice Guideline3, a class of antidepressants referred to as SSRIs (selective serotonin reuptake inhibitors), and related medications, are recommended as the initial pharmacological treatment when patients with borderline disorder are suffering from depressed mood, mood instability, sensitivity to rejection, inappropriate intense anger, depressive “mood crashes,” or temper outbursts. This conclusion was reached primarily on the basis of three placebo controlled clinical studies that utilized higher than normal doses of medications in this class. A recent placebo controlled trial of another SSRI, fluvoxamine (Luvox), in women with borderline disorder demonstrated that the medication improved rapid mood shifts, but not impulsivity and aggression.

Some of the enthusiasm for the use of SSRIs in borderline disorder derives from a number of research studies that have demonstrated disturbances in serotonin function and genetic abnormalities in patients with borderline disorder.  These findings provide the scientific rationale for the use of SSRIs in the treatment of this disorder, as the SSRIs increase serotonin activity in the brain4. Therefore, it is surprising that so few studies with these agents have been performed in subjects with borderline disorder, and that those demonstrate a relatively narrower range of therapeutic effect than antipsychotic agents. Although there are not as many studes demonstrating the effectivenss of SSRIs in borderline disorder as there are of antipsychotic agents, these medications appear to be useful in treating some symptoms of the disorder.

The main side effects encountered by many patients taking an SSRI are decreased sexual interest, motivation, and capacity to perform and respond sexually, weight gain, a flattening of emotional response, and the precipitation of hypomanic symptoms in patients who have co-occuring bipolar disorder. Not all patients taking SSRIs experience these side effects, and some who do consider them a tolerable trade off to the reduction of their symptoms. Current concern also has arisen about the possible increase in suicidal behavior of depressed people treated with SSRIs, especially adolescents.

MAOIs

Another class of antidepressants, the monoamine oxidase inhibitors (MAOIs), may also be useful in patients with borderline disorder. Two placebo-controlled studies of the MAOI phenelzine (Nardil) have suggested that it may be more effective than SSRIs. However, orally administered MAOIs have the potential to produce very serious, even life-threatening side effects if used improperly. Therefore, most physicians use an MAOI for patients with borderline disorder only after other medications have been tried, and the physician feels confident that the patient will follow the necessary rules that have been clearly outlined to him or her. A new skin patch delivery form of an MAOI (ENSAM) given at its lowest dose appears to eliminate the usual dietary concerns involved in orally administered MAOIs.

Tricyclic Antidepressants

Some antidepressants appear not to be useful in treating patients with borderline disorder. The tricyclic antidepressants amitriptyline (Elavil, Amitril, Endep) and nortriptyline (Pamelor, Aventyl) may even worsen the condition of people with borderline disorder. Other tricyclic antidepressants should also be used with caution in patients with borderline disorder.

Mood-Stabilizing Agents

Not all patients with borderline disorder respond adequately to antipsychotic agents or antidepressants. Under these circumstances, other medications may be useful, either used alone or in conjunction with one or more of the other medications described above. A group of medications referred to as mood-stabilizing agents has been shown to help reduce symptoms in some patients with borderline disorder.

Antiepileptics

One class of mood-stabilizers includes divalproex (Depakote), topiramate (Topamax), lamotrigine (Lamictal), and carbamazepine, (Tegretol). These medications are referred to as antiepileptic drugs as they are commonly used for people suffering from partial complex seizure disorder. Partial complex seizure disorder has its origin in the temporal lobes of the brain, a brain region important in the generation of emotions.

Four placebo-controlled studies of medications in this class in patients with borderline disorder have now been reported, three with topiramate and one with divalproex. These studies consistently found that these drugs reduce impulsive, angry and hostile behavior. One study, with topiramate, also demonstrated decreases in anxiety, interpersonal sensitivity and general severity of symptoms. In borderline disorder this class of medications does not appear to reduce depression, paranoid thinking or psychotic behavior.

Medications studied and used in the treatment of Borderline Personality Disorder.

Antianxiety Agents and Sedatives

Anxiety and poor sleep are common symptoms of borderline disorder. In other disorders, the benzodiazepines are most frequently used for these symptoms. These include diazipam (Valium), alprazolam (Xanax), temazepam (Restoril), flurazepam (Dalmane), and triazolam (Halcion). These medications should be used with caution in patients with borderline disorder because of their high addictive potential and a reported capacity to increase impulsive behavior in patients with the disorder.

Some patients with borderline disorder also experience adverse responses, such as impaired perceptions and greater sleep deterioration, to the non-benzodiazepine sedative zolpidem (Ambien). Therefore, if this medication is prescribed for you, be aware of this possible problem.




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flex55
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« Reply #2 on: July 12, 2006, 09:54:41 AM »

Dr. Heller Discusses BPD

www.biologicalunhappiness.com/4h.htm

"...Epilepsy was once thought to be a psychiatric problem, until the underlying neurological abnormalities were understood.  Researchers have uncovered medical and neurological abnormalities in borderlines.  Many symptoms are likely due to malfunction in the brain's limbic system.  In my opinion, the borderline personality disorder is primarily a medical problem.  It can now be treated.

The Borderline Experience


Imagine you are faced with a minor stress - a flat tire, a clogged-up sink, or a trivial disagreement with your spouse, friend, lover, child, etc.  Instead of finding an acceptable solution, your mind seems to panic.  A sense of unease develops, possibly causing discomfort in the stomach or chest.  Feelings of anxiety complicate the increasing sense of uneasiness and restlessness.  This is followed by progressively worsening anger - eventually becoming a rage so strong it overwhelms you - even though you realize it's excessive.  Over the next few minutes to hours, other negative sensations creep in - including memories of past hurts - until you are experiencing virtually every bad emotion a human can feel.

You feel trapped and vulnerable.  Your psychological defenses are overwhelmed by unbearable emotional pain.  You feel depressed.  You find yourself unable to cope as your mind and body are now in a full scale panic.  You lose proper perception of reality - jumping to erroneous conclusions in a futile effort to make sense of what's happening.  As the pain continues to intensify the nervous system creates bizarre sensations such as emptiness, numbness, and unreality.  You become incapable of rational thinking as the panic continues to worsen.

Your mind now desperately tries to find a way out of the pain and searches for solutions.  It recalls past activities that have made you feel better.  Once a method is found, your mind frantically forces you to pursue that activity to a self-destructive excess - finally resulting in a biochemical rescue.  Brain chemicals are released that stop the pain and let you feel 'normal' again.

But how can you ever feel normal again knowing that such a horrible experience will return?  How can you feel normal again when your self-destructive and inappropriate behaviors are witnessed by family, friends, employers and/or co-workers?  How can you feel normal again when those behaviors result in financial, interpersonal, physical, or legal trouble?

For those not afflicted with the Borderline Disorder this is a nightmare we hope never happens to us.  Borderlines experience it over and over - especially when confronted with stress.  While individual borderlines may feel some symptoms differently, the horrible feelings described in the first paragraph (called 'dysphoria' intrude frequently into a borderline's life.

Borderlines will do almost anything to make dysphoria go away.  Most impulsiveness and self-destructiveness is an effort to relieve dysphoria.  Some borderlines, especially those suffering very severely, will literally cut their bodies during dysphoria.  The self-mutilation is itself painless (the cuts don't hurt), yet it relieves the dysphoria.

Borderlines also suffer from intense, frequent and unpredictable mood swings that can cause 'dysphoria' even without stress.  The mood swings cripple a borderline's efforts to live a happy, successful life.  Borderlines are victims of an incredibly painful illness...

Like victims of epilepsy, muscular dystrophy, and neurofibromatosis (the 'Elephant Man's' disease), victims of borderline neither asked for, deserved or caused their affliction.  The symptoms can be so unpleasant to those interacting with borderlines that feelings of compassion and understanding may be difficult or impossible to feel.  Borderlines desperately want to be loved, but their illness makes them at times seem unlovable.  They are terrified of being abandoned, yet are powerless to keep the illness from destroying relationships.

This is the borderline experience.


The Facts

...Genetic factors are important - borderline tends to run in families.  The risk of developing borderline is 6 times higher when a close relative has the disorder.  In studies of identical twins, researchers have discovered that many personality traits are genetically determined.  There is an association between some personality characteristics and blood type (called 'blood group antigens'.

Borderlines commonly suffer from other disorders as well.  PMS, depression, hypothyroidism, vitamin B 12 deficiency, other personality disorders, anxiety, eating disorders, and substance abuse problems are the most common.  Intelligence is not affected by the disorder, but the ability to organize and structure time can be severely impaired.  There is no association with Schizophrenia.

...While many borderlines suffered from abuse or neglect in childhood, some developed the disorder from head injuries, epilepsy, or brain infections.  Early parental loss and incest are commonly associated with borderline.

The facts indicating a medical origin are impressive: Brain wave studies are frequently abnormal.  Neurological physical examinations are abnormal.  Sound interpretation is impaired.  Memory and vision are impaired.  Glandular function may be abnormal.  Sleep is abnormal.  The response to some medications is bizarre.  When injected intravenously, the medication procaine normally causes drowsiness, but a borderline will feel the 'dysphoria' described in the first paragraph.  If borderline was exclusively an emotional illness, why would all these medical neurological abnormalities be present?

Borderlines likely have abnormalities with the neurotransmitter 'serotonin' - an incredibly important brain chemical.  Serotonin problems can cause anxiety, depression, mood disorders, improper pain perception, aggressiveness, alcoholism, eating disorders and impulsivity.  Excess serotonin can depress behavior.

Serotonin deficiencies can cause many problems, especially suicidal behavior.  Low levels of serotonin increase the risk of self-destructive or impulsive actions during a crisis.  The most violent suicides (hanging, drowning, etc.)  are usually committed in patients with low serotonin metabolite (waste product) levels in the spinal fluid.  In those who attempted suicide unsuccessfully, 2% will likely be dead within one year.  If the serotonin metabolite level is low, that risk increases to 20%.

Treatment

Due to new developments in medicine, borderlines can now be treated and often cured.  The medication fluoxetine (Prozac) usually stops most of the mood swings in a few days.  It is, in my opinion, as big a breakthrough for borderlines as insulin was for diabetics.  Borderlines generally see themselves very profanely.  I frequently tell my borderline patients 'you're not an *#%@*, your brain is broken.' Once this concept is understood, the borderline patient usually feels an enormous sense of relief.  They need to know they have value as a human being.  Feelings of desperation and hopelessness are often replaced by optimism and motivation once Prozac stops the mood swings and the patient begins to realize that a happier, more successful life is possible.

All borderlines need psychological counseling.  It's almost impossible to live for years as a borderline and not need psychological help.  While the underlying problems are probably structural within the brain, the borderline is left with a lifetime of bad experiences and inadequate skills for recovery.

No medication should be given without proper medical supervision.  This is particularly true for the drugs used to treat the borderline disorder.  Some medicines make the symptoms of borderline worse, especially amitryptilline (Elavil) and alprazolam (Xanax).  Possibly a third of borderlines may suffer from low thyroid (hypothyroidism) - despite a normal 'TSH' blood test.  They may need to take thyroid medication.

The antidepressant fluoxetine (Prozac), a serotonin increaser, virtually eliminates the mood swings.  Feelings of anger, emptiness and boredom are often eliminated or reduced as well.  Most borderlines I've treated consider Prozac to be a miracle.  While some need the medication indefinitely, many have been able to stop it after a year without the mood swings returning.  Side effects are rarely a significant problem.

Neuroleptics...have been proven effective.  They are remarkably helpful for treating dysphoria and psychosis, and can be preventive when the borderline is undergoing stress.  They seem to 'put on the brakes' when the thoughts are racing.  They should only be used as needed, like using an antacid for heartburn.  These medications can be effective at low doses, and must be taken with great caution.

While medications can help with some symptoms, the brain is clearly broken.  After a stroke, the brain needs therapy to let the healthy areas take over for the broken ones.  The same is true for recovering borderlines.  I feel strongly that the brain must be retrained.  Affirmations...will work, as the human brain can believe almost anything if told it enough times...

The psychology of positive thinking is very helpful.  I strongly recommend massive brain re-education.  Devote as much time as possible for 3-6 months reading positive self-help books and listening to motivational tapes - especially those by the motivational speaker Zig Ziglar...

Sometimes symptoms of 'temporal lobe' involvement (similar to epilepsy) complicate the disorder.  Common symptoms include unawareness spells, feeling like things are unreal, and numbness of body parts.  These symptoms are more common under stress, depression, severer dysphoria, and incest crisis.  They can be treated with the epilepsy medication carbamazepine (Tegretol)...

Borderlines are VICTIMS - they did not cause their illness.  They do not want their illness.  They want to be treated and possibly cured.  They deserve that opportunity.

The National Institute of Mental Health (NIMH) has been the single most influential source of unbiased study and information regarding the true biology behind the borderline personality disorder.

Landmark studies, such as those produced by Drs. Cowdry and Gardner in 1987 showed the effectiveness of Tegretol (carbamazepine) and neuroleptics, and the dangers of Xanax (alprazolam).  This article was published in the Archives of General Psychiatry Feb 1988.  A subsequent article showed that conclusions of low brain serotonin in the BPD were erroneous, low levels were associated with suicide, not the BPD.

Dr. Cowdry was the acting director of NIMH for the last few years, and will likely be involved with further research."



Leland M. Heller, MD

WJNO Radio: Monthly radio show for 4 years, ":)octor on Call"

Multiple local television news spots in Palm Beach County 1992 - 1995

"The Geraldo Show" - December 1, 1992 

University of Michigan, Ann Arbor, Michigan

9/72 - 12/74 No degree - accepted to medical school after 28 months

Medical School:

University of Miami School of Medicine, Miami, FL

September 1975 - June 1979 Doctor of Medicine Degree

Internship and Residency:

Tallahassee Memorial Regional Medical Center

Family Practice Residency Program

July 1979 - June 1982
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Ashlynn
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« Reply #3 on: July 12, 2006, 04:29:47 PM »

Wow - thanks for posting these articles.  I do think of my BPDs as victims of their disorder.  Many nons on this board have been abused and deeply hurt by their BPDs (especially the children of), so it is hard for them to see BPDs as victims themselves.  With all of the venting and talk of NC it is good to be reminded that the BPD's pain is worse than ours.  At least I know that is so for my mother and my daughter.  This knowledge has allowed me to get past the anger and to feel compassion.  After all, it could easily have been me.

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Serenity.
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« Reply #4 on: July 12, 2006, 09:17:35 PM »

Wow, Thanks for sharing these articles with me. You might of just saved my ex-fiance's life and I'm not kidding, he said he was on zoloft and wellbutrin and he was really close to killing himself on these meds. They were making him worse because they were the wrong prescription. He told me if I hadn't left him two months ago, he would have continued taking those pills and who knows what the end result would have been. I was so upset when he told me he decided to quit them but he said nothing was wrong with him and after I left he didn't care no more and he wouldn't take the meds. i have read so many things on BPD for the past couple weeks and nothing to show my ex-fiance to pinpoint EXACTLY what he was feeling and why he would take off out the door and leave for days. It would be over  things I considered 'nothing' that would set him in these raging moods. He was filled with hate, anger, rage and uncontrollable emotions that flooded him. He would tell me he was very depressed than finally suicidal all the time and felt so much sadness and pain when i 'triggered' him. Well that's who he'd blame constantly for his troubles; ME. After trying to explain to him I did alot of reading on BPD and that my counselor believed his pyschiatrist misdiagnosed him (with 'clinical depression'   He says after I sent your article to him, he wonders how many other victims are out there that she misdiagnosed! ) i saw your article by this Doctor that summed up everything he's been doing to me and his behavior was identical to this! First one to fully explain his dramatic over emotional mood swings and rages over very minimal everyday events. I emailed it to him and was afraid he might get very angry with me for claiming he had a mental illness and was surprised at the voice at the other end of the phone. He told me that is exactly what he's been feeling and finally something put it into actual words that it felt like how he always felt. He tried to tell his psychiatrist he was way more than depressed and he knew something else was 'wrong' with him and the pills weren't working. They only made him dizzy and feel drugged. (he was on zoloft for two yrs she prescribed, then wellbutrin these last few months on top of that which made him mean, that's why I took the kids and left him; he threatened to kill me on these meds; they were making him more bizzare and more suicidal like the article said.) I told her of my concerns, suicidal threats to me and suicidal harm to himself and she just said he was fine in my office a few days ago and I'd have to file the concern with the courts to make him go the the hospital or whatever. Nice concerned woman huh? ;==

He's very mad that she didn't know to diagnose him with BPD since he's told her of many of the symptoms and rages. How can she minimize that down to depression? Well, I just want to say, his is taking the path to recovery now and wants to try the prozac even though he was afraid it might not work like the zoloft didn't. I am happy he's admitting this illness sounds like what he has. He also said he was going to make a copy of this so that he could show his counselor. What a difference you made to one life I know of, thanks so much! God bless us all in hoping these cures start working.
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hope
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« Reply #5 on: July 20, 2006, 11:00:07 AM »

My BPD husband tried prozac - no noticeable difference.  Then he switched to Wellbutrin and Risperdol .  The doc (family clinician not psychiatrist) insisted that he needed to take it for the rest of his life if he wants to avoid being imprisoned.

I'm amazed we're finally living the life we dreamed of.  The crazy rollercoaster ride stopped, It's a miracle.
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bianda
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« Reply #6 on: December 13, 2006, 10:17:27 PM »

The doctor just added Topamax to my BPDD's meds...she is taking Effexxor XR.  The doctor is trying to address the rapid cycling mood swings that BPDD exhibits and the binge eating.

Has anyone observed positive results with the use of Topamax?

I appreciate your input...

Thanks,

Bianda :Smiling (click to insert in post)
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« Reply #7 on: December 14, 2006, 02:48:12 AM »

www.crazymeds.org/topamax.html
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trinity_n_fl
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« Reply #8 on: December 14, 2006, 07:22:02 PM »

I was given Topamax for a few weeks and I had to stop it. First, I would sleep an entire day every time they increased the dose. By the third week, I couldn't read out loud, which is very important for my line of work. Some folks call it Stupimax, and I can see why! But everyone's different. One of the good things is that one can lose weight on Topamax. Most psych meds cause weight gain, so that's a plus.
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bianda
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« Reply #9 on: December 14, 2006, 08:47:49 PM »

Thanks for the info.  I have been online looking in on this med. and everything talks about the weight loss, which in my BPDD's case is a good thing because she is a binge eater.  In addition, I read how it is also used to treat migraines which again in her case she also suffers. Also, it has been used with alcohol abusers which is my BPDD's drug of choice.  She demonstrates the rapid cycling Bipolar type and the Topamax is recommended for that particular type.  I know with any medication it is hit or miss because of biological differences so I can only keep my fingers crossed and hope this is the one that matches her.  I did read something about it being dopamax because it makes people act like dopes but I am hoping that won't be the case for her.  Whatever wiring is screwed up in her head I am hoping this med. will reconnect for her. 

Also she has an appointment next Tuesday with a therapist who specialiizes in DBT.  Let's hope she goes as he is an hour away from her college.   

Bianda
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mr_anderson1
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« Reply #10 on: December 15, 2006, 01:22:24 PM »

Mine takes topomax and it hasn't made her stupid or anything. Come to think of it, she is sleeping better. Her migrains have been reduced to one every 1 or 2 months. Both good and bad as I did enjoy the calm times when she's incapacitated. 8)

She has lost weight which has improved her mood immensly. I haven't noticed any change in her uBPD symptoms because of it, but she is working on them separately, without talking about it, by herself.  :Smiling (click to insert in post)
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« Reply #11 on: December 18, 2006, 11:06:56 AM »

My BPDwife takes Topamax for migraines, and it has helped to reduce their frequency, duration, and intensity. Her doctor is a very observant, sometimes I think sneaky, health care provider. I wonder if he doesn't suspect BPD and thought the Topamax might have an added benefit of a mood regulator. If so, he's a smart man.
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« Reply #12 on: December 18, 2006, 04:01:02 PM »



   I have taken Topomax for migraines. Seems to work really well, don't seem to be any crazier than before?
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« Reply #13 on: November 07, 2007, 03:48:10 AM »

The BPD in my life has decided to go off Paxil and is currently drug-free.  He's also decided to forego therapy, as "there's nothing wrong him - it's the rest of the world that doesn't know the difference between Right and Wrong as he does).

My question is, since he's off Paxil, was that really the wrong drug for him to be taking anyways?  He wasn't THAT great on Paxil, except that he didn't care about much and had less 'highs' and 'lows', for the most part.

I wanted to throw this Rx question out there if ever I am in a position to recommend something different to him or his doctor (unfortunately the medical attention he's received has been really lame and he's never taken seriously by medical personnel - he puts up a good front with them, I think).

Any suggestions or comments would really be appreciated!
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« Reply #14 on: November 07, 2007, 08:42:39 AM »

This post reminds me of something that I learned last week in T.  I was telling my T how my exBP is supposedly now on a certain medication that was prescribed to him by his family doctor for depression/bipolar.  Hearing this had made me a little jumpy, why, I am not sure, being that I am not going to ever go back with him, but I can't lie, the thoughts of "What if this gets his mood regulated and he ends up being a pretty good guy",...you know..thoughts like that.

First, she shook her head and told me that family dr.s OFTEN have no idea what they are dealing with in terms of mental stability/personalities, and push the depression/bi polar dx too much without having any indepth look into the patient.  She then proceeded with this:

She, my T, sat there and held out both of her hands, palm face up, and then closed both to make closed fists.  One fist represented depression and the other fist represented personality.  She said that the medicine that he is on may help to subside his feelings of depression, but that it will not touch his personality.  He is who he is at his core.  That's really something to think about, or at least I think it is.
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« Reply #15 on: November 07, 2007, 09:55:30 AM »

Staff only

Going off meds without dr supervision I have heard is very dangerous, especially cold turkey.

None of us are medical professionals or in any capacity qualified to expense medical information.

I suggest you contact another medical practitioner who can help you here with qualified advice.

Good luck

Peace4us
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« Reply #16 on: November 07, 2007, 01:57:46 PM »

My husband had been on Paxil and Zoloft before he was diagnosed with BPD.  Once he was diagnosed, our doctor put him on Prozac (a higher dose is needed for BPD than what is normally used for depression) eventually building up to 80 mg. where he had the maximum benefit.  Studies have shown that Prozac works better than Zoloft in treating some of the borderline symptoms such as chronic anger and emptiness.  Both work equally well if one just has depression and nothing else.

  He is also on a mood stablizier, Tegretol, medication for his comorbid ADHD and he has an as needed antipsychotic that he uses when he begins to feel overwhelmed, stressed or the beginning of dysphoria.  This medication regimen has worked very well for him. 

  Going off Paxil cold turkey is not recommended as it can cause severe withdrawal side effects.

  Abigail
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« Reply #17 on: November 07, 2007, 09:11:02 PM »

My daughter was first prescribed paxil but had a terrible time with this drug - she had bad headaches and was having visual disturbances (she was seeing flashes of light and having blurred vision).  She was taken off the paxil and put on zoloft and was taking a low dosage for a couple of years.  Though the zoloft certainly didn't cure her illness, I thought her depression and anxiety were eased some.  The doctor had just raised her dosage of zoloft but unfortunately dd decided that she didn't need to be taking that anymore either and now she is taking no medication and having no therapy.  Time will tell, but I don't think her strategy is going to help her deal with her many issues.  I don't think she ever sleeps, either.  I have read, though, that prozac is the drug of choice for treating some of the symptoms that go along with BPD.

Grace





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« Reply #18 on: January 08, 2008, 11:49:39 PM »

ok..I gave The Eggshells book to 2 people..a friend and  a family member..Both of them said after raeding it they conclude that this disorder can be cured with medication..My correct understanding after reading that book and other books is that meds help with anxiety a bit but on tHE MOST  PART if one truly has BPD any cure wil takea good 8-10 years of intense therapy..I conclude that by specifically nothing those that write about their recovery,most notably A.J Mahari.How did we see 2 diffrent things from this book? So i was also accused (the BPD who has been diagnosed) that this forum is brainwashing me..I feel like I have never been so clear in my thinking..Thats how I feel..so of course I stuck up for all you guys..I had a really hard day.Hope yall had a better one!
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"A friend is one to whom one may pour out all the contents of ones heart.Chaff and grain,together.Knowing that the gentleness of hands will take and sift and keep what is worth keeping and blow the rest away"....
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« Reply #19 on: January 09, 2008, 02:08:31 AM »

AJ Mahari was treated before DBT was created, I believe... DBT is having great results and some people are better within a year if they are serious and comitted to the therapy.

google it...

Mostly, it is the determination of the patient to get through it and to get healed.

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« Reply #20 on: January 09, 2008, 01:25:42 PM »

  BPD can not be "cured" but it can be managed with the right medication treatment much like diabetes, staying away from alcohol (they are "allergic" to alcohol) and addictive substances, and therapy, especially retraining the brain with positive affirmations and correct thinking.  And of course, getting all of the comorbidities diagnosed and treated as well.

   My husband would be considered "high functioning" and he has been treated by Dr. Heller with medication since he was diagnosed three and a half years ago.  He has improved greatly and has an additional medication that is taken on an as needed basis when he feels stressed or overwhelmed, or even before a stressful event that you are aware of (say, an upcoming situation that you know will be stressful).  If taken soon enough, it calms him down and prevents the development of a rage and eliminates the anger.  You do have to learn to recognize your moods so that you know when you need to take the extra medication.

   Therapy is much more effective and can be accomplished in a lot less time if they are being properly medicated.  Each circumstance and situation is different, but you are more likely looking at months instead of years of therapy.  Without the proper medication, therapy may take numerous years or may not work at all.

   Dr. Heller (www.biologicalunhappiness.com) has had numerous success stories of which my husband is just one.  One of my friends and several members of her family have also been helped tremendously by Dr. Heller, along with my neighbor's daughter and a friend of a friend.  My 26 year old daughter is also being treated for BPD but hers is a milder case and with more anxiety problems than anger.

  Abigail
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« Reply #21 on: January 09, 2008, 03:30:02 PM »

I think some are more capable of recovery than others. As has been pointed out A.J. Mahari made her journet before Dialectical Behavioral Therapy even existed and Rachel Reiland apparently had alot of success through old fashioned psychoanalysis.

I'm not one that thinks medication is the answer to this disorder, although it might make the hard work involved in recovery easier. What particularly interests me is that a new type of cognitive/psychodynamic therapy called Schema Therapy has been shown to "cure" a majority of BPs of their core symptoms within 3 years. This is where we need to be focusing our attention. Nothing so far has had these kinds of results.
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« Reply #22 on: January 09, 2008, 08:17:02 PM »

Please remember that if the BPD in your life was "cured" (or even recovered), you might not find them as fetching.  The intense "goodness", the lack of boundaries that makes them "fun", the often child-like vulnerability that is appealing in some ways, is as much a symptom of the disorder as the difficult stuff... and that kind of stuff might change dramatically if the BPD person recovers.  Also, many nons can't really appreciate someone who is kind and loving and stable..  they need chaos due to family of origin issues.  If the BPD becomes stable and consistent... well, he/she might not be as exciting anymore.
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« Reply #23 on: January 10, 2008, 07:20:51 PM »

Here's my experience with my xBPD and medication.  He was given Paxil and you know what, it kind of lessened his rages and made him 'snap out' of things a lot faster.  He was more rational, I suppose?  Some of these medications take two or three weeks to kick in, but my ex and I noticed changes within two days.  I just read somewhere that the faster they work, the greater need (the brain has been starved for whatever is in them).

But the problem is - and you'll hear this a lot - is that anybody that has a pysch/mood disorder feels that they are 'cured' after taking the meds.  Heck, they don't need them at all!  They believe they can function just fine without them, and eliminate the very common side effects at the same time.  So nine times out of ten, they wean themselves off.  Or go cold turkey.

All I can say is that it breaks your heart to see the monster return a short while after.  You see it.  They don't.  And future attempts to encourage medication re-start gets more and more difficult.  It's my opinion that after they come off, they get WORSE.  My experience with my ex went from bearable emotional abuse, to devastating emotional abuse, to physical abuse AND damaged-soul-forever emotional abuse.  I obviously can't stick around for the next stage.


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« Reply #24 on: January 12, 2008, 02:52:52 AM »

Good observation, JoannaK.  I now remember reading in a clinical article about the fact that the person you were originally attracted to may or will not be the same if on medication (and/or treatment).  What drew you to them originally will be dampened and you might not feel the same way.

Also, when I think of my ex when he was on Paxil, I felt a bit disconnected from him in a bored kind of way.  The emotions that I grew to live with and EXPECT, were now dulled because of the medication.  Him and his personality became a stranger to me.  I know for a fact that I wouldn't have been drawn to this guy if I was not vulnerable at the time.  He just wasn't my time in every, every way.  I guess that says something about me and my mind.

I also wanted to clarify that no, this can't be cured.  Just controlled.
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