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Author Topic: TREATMENT: Medications  (Read 7537 times)
Abigail
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« Reply #30 on: February 14, 2008, 03:43:26 PM »

TonyC,

  I don't know if your ex was officially diagnosed with BPD or not but studies have shown that Xanax has been found to make BPD worse!  If a doctor is treating patients for BPD he should know that. 

  The meds my husband is on (prescribed by Dr. Heller) are not any of the ones you listed and are generally not sedating.  The Tegretol can be in the beginning but my husband takes it at night anyways.  One of the meds, Risperdal, is sedating but that only needs to be taken in a severe crisis.  And if you follow Dr. Heller's instructions perfectly, that will be a very rare event.

   Before being treated, my husband slept a lot.  Treated with the right medication, he is awake and productive.  He also has ADHD and takes Adderall for that. 

  Abigail
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« Reply #31 on: February 14, 2008, 04:21:28 PM »

Mrbluesky,

   There is a definite correlation between ADHD and BPD.  Conversely, at least 25% of those with BPD have ADHD as well (according to one study), although Dr. Heller suspects it is higher and so do I.  I know 13 individuals, including my husband and daughter, who have officially been diagnosed with BPD and at least 10 also have been diagnosed with ADHD.  I don't know enough about the other three individuals to know if they have ADHD or not.

   And of those who I strongly suspect have BPD, many of those have ADHD as well.  And the vast majority were untreated for their ADHD. 

   The book, "Attention Deficit Disorder--The Unfocused Mind in Children and Adults " by Dr. Thomas E. Brown is very interesting.  It describes the executive function deficits in those with ADHD and there is a chapter on emotional dysregulation.  When you read it, much of it sounds like BPD.  Check it out if you can find the book at a library.  I began highlighting the references in that chapter that sounded like a description of BPD and there were many.

  Abigail
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« Reply #32 on: February 15, 2008, 01:57:35 PM »

Abigail,

I found your comment regarding Xanax very interesting. During the last couple of months, J was eating Xanax like jelly beans trying to manage the stress that he was under.  I've tried to find some research showing the counterindication for BPD.  Can you help?

Thanks!
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« Reply #33 on: February 15, 2008, 02:12:40 PM »

apparently I didn't search this correctly the first time through:

www.toddlertime.com/dx/borderline/integrated-treatment-BPD.htm

Thanks for pointing this out Abigail.
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« Reply #34 on: February 16, 2008, 06:01:26 PM »

Well, now that I've read this, I can track back a block of rages to his hitting the Xanax bottle.  He stopped taking Prozac when we met because of the sexual side effects.  When he found out his ex was having an affair when she divorced him (3 yrs later), he got a script for Xanax.  Things went to hell.

He is also a big "straight" vodka drinker.  I wonder if he isn't allergic as Dr. Heller asserts.  He drank enough that I'm not able to correlate the two...but I wonder.

Hearing descriptions of him and watching him in action as an adult, I would bet the house he's ADHD.  Can't shut up.  Going either 90 or nothing.  Can't finish ANYTHING.

Lastly, and honestly, an issue I might actually be able to discuss with him, are three concussions he suffered as a teen.  He tells the stories of these experiences all the time.

What I would give to get him to Dr. Heller.  Heck, what I would give to lay eyes on him again.

Great thread!
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AJMahari
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« Reply #35 on: February 28, 2008, 09:20:30 PM »

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.

Yes I am really that ancient Smiling (click to insert in post) I was treated before DBT was created. However, I did, among other types of therapy have a lot of Cognitive Behavioral Therapy which DBT is an off-shoot of. I also wasn't ever suicidal nor did I engage in parasuicidal behaviour so really, even if DBT, in its initial implementation was available I wouldn't have been the type of client most in need of it as it was inititally implemented for and mostly targeted toward those with unending suicidality, parasuicide and severe self-harm. I did engage in self-harm for a period of time when I had BPD, but again, not as majorally as many.

Of course, DBT is much more widely applied to the treatment of BPD now than it was intitally.

I totally believe that pills cannot cure or really effect recovery from BPD at all. They, at best, control some symptoms of some things of some aspects of BPD but that's about it, if that. Not to be controversial here but I do have a lot of concern about all of the medicating of those with BPD going on. I think for some they are over-medicated and not "treated". That's not in anyone's best interest. Also the amount of side effects of lots of medications alone, let alone in the astounding combinations that are increasingly being given to borderlines likely is creating other problems or exacerbating things that may not be well understood in many individual's experience.

I would also like to add again from my own experience that I recovered from BPD without ever being on any psychiatric medication whatsoever. So I wonder how the professionals pushing the pills would explain that?

Interesting, in this thread the usuage of the words "cure" versus "recovery".

I just wanted to say that in my experience as one who has recovered and as one who didn't ever take psychiatric meds or anti-depressants on that journey or since, I know first-hand that "meds for life" aren't necessary.

Your reference to willpower is also interesting. I think that taking personal responsibility, making a commitment, and a stubborn determination were the definite foundational pieces needed in my recovery. Some may call that willpower but willpower is often also associated with the mere controlling of one's impulses and/or actions in terms of "self-control". Those with BPD must first find and ressurect the lost authentic self and cannot hope to have control over what is a lack of self, therefore, I would say that self control isn't a part of the equation until well down the road to recovery. Learning to control impulses is a part of the recovery process but after one recovers, it has been my experience anyway that it isn't any longer about controlling impulses. Recovery means that one has resolved the underlying abandonment trauma that drove the impulses - essentially what I refer to as "the abandoned pain of BPD" - that needed to be controlled in maladaptive and pathological ways so that the borderline false self could continue to keep the abandoned pain at bay and out of the conscious awareness of the person with BPD.

I think you are right on about the need to be stubborn, for sure, however Smiling (click to insert in post)
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« Reply #36 on: February 28, 2008, 09:38:03 PM »

Staff only

The use of medication in the treatment of BPD is commonly practiced by the leading treatment centers.  Robert Friedel MD maintains a very contemporary schedule of treatment models.  :)r. Freidel is recognized by the NEABPD and he has testified before the US congress. BPDdemystified.com

There is controversy (meaning not all clinicians agree) on which medications are best in the treatment of BPD largely because most of the drugs are prescribed "off label"... meaning large clinical studies have not been performed to mediate the individual experiences and preferences of different clinics.  Here is the definition of 'off label"  click here

It's interesting to see Mary Zanarini's (Harvard) distinction in the use of the terms recovery and remission in BPD.  Zanari is also recognized by the NEABPD and these are good definitions for our use.

Extended Recovery=remission of symptoms and having good social and vocational functioning during the previous 4 years.

Recovery=remission of symptoms and having good social and vocational functioning during the previous 2 years.

Remission=remission of symptoms

https://bpdfamily.com/message_board/index.php?topic=117735
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« Reply #37 on: March 01, 2008, 11:53:56 AM »

GF had long taken 10mg of Prozac. When generic was prescribed, she unwittingly began taking a 20mg pill every day, effectively doubling dosage.  I noticed that impulsiveness was greatly diminished with the greater dosage, of not eliminated. Has anyone else noticed this improvement from Prozac?
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« Reply #38 on: March 01, 2008, 01:31:00 PM »

That would almost undoubtedly happen. They're emotions are blunted too which I suppose would be a positive if the only other choice was volatile.
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« Reply #39 on: March 01, 2008, 05:49:42 PM »

www.sciencenews.org/articles/20080209/fob1.asp

This article might be of interest to you.  It is brand new research on the effect prozac has on the neurons in mice brains.  Basically says it causes the neurons in the hippocampus to mature faster.  Since people with BPD have smaller than usual hippocampi, prozac may be something that counteracts this.
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« Reply #40 on: March 20, 2008, 03:18:46 PM »

Pennsyvania area study for anyone interested in this information.

Regional Expert:

Emil F. Coccaro, M.D.

Dept. of Psychiatry

Eastern Penn Psych. Institute

Medical College of Pennsylvania

3200 Henry Ave.

Philadelphia, PA 19129

215-842-4192

VOLUNTEERS NEEDED FOR A BORDERLINE PERSONALITY DISORDER STUDY:

Do you have symptoms of feeling abandoned, anxiety, anger, feeling bad about yourself and difficulty in relationships with others? Eli Lilly is conducting a research study assessing whether the antipsychotic drug Zyprexa (olanzapine) will be effective in controlling symptoms of borderline personality disorder (BPD). The study is looking for men or women 18 to 65 years of age, with this diagnosis. The study will last-up to 24 weeks. Subjects who qualify will be closely monitored by a faculty psychiatrist and receive study medication at no charge. They will be compensated up to $600 for participation in the study. For more information, or to see if you qualify, call Louise  at 1-888-602-9900.
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« Reply #41 on: March 20, 2008, 04:13:45 PM »

   Thanks for the info.   don't know anyone with BPD in the Philly area.

                                                                                                                                                                  Dr. Heller sometimes uses Zyprexa for periods of dysphoria, but I think they only take it for a week.  My daugher took it for a week, I believe, and so did one of my friends who has BPD and bipolar.  One of the biggest problems with it is that it causes weight gain.  But it does help for the dysphoria.
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« Reply #42 on: March 20, 2008, 04:23:56 PM »

My ex was on this. She gained weight and tried to commit suicide.

~AguyD
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AJMahari
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« Reply #43 on: March 21, 2008, 09:51:07 AM »

A word of caution here. Zyprexa has been in the news as a drug (you can read about this on lots of web sites by the way) that not only causes incredible amounts of weight gain but that is seriously being looked at and there are law suits emerging and being pursued against the drug company because of a high incidence of diabetes that appears to be associated with the drug. It is also alleged that Eli Lilly sought to supress this information.

My BPD/NPD ex was on this drug. Three things, she gained a lot of weight, she got diabetes, and it DID not help her paranoid issues. It seemed to slow down the shifts in moods ever-so-slightly but otherwise was ruining her health and not really helping her emotionally.

Just my two cents worth here but I would not want to have anyone I cared about enter such a study.
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« Reply #44 on: March 21, 2008, 10:11:19 AM »

Interesting information AJ.

I did a quick Internet search - if I understand it correctly, these are known side effects that can occur with this entire class of drugs... so your caution is very valid.  I saw one estimate that said 7-10% of patients.

The FDA said that there are tests that can be done to identify which patients are at risk. “Physicians can use the genetic information from this test to prevent harmful drug interactions and to assure drugs are used optimally, which in some cases will enable patients to avoid less effective or potentially harmful treatment choices,” ~Lester M. Crawford, Acting FDA Commissioner (12/2004)

The first lawsuit (State of Alaska vs Lilly)  alleges that the manufacturer was too aggressive in its marketing and did not disclose the risk adequately - and as a result, people have been needlessly injured. As I understand it, the state is not asking that the drug be pulled from the market.  But, who knows what's next in these things.

So clearly, if anyone is considering this route, they should be proactive with their physician about learning about the risks, the screening tests, the monitoring tests, and the alternatives.

Thanks for bringing it up.

Skippy

PS: What I looked at:

Drugs.com

Zyprexa Lawsuit


Risperdal and Seroquel Lawsuit

Psych Drug Truth

Seroquel

Zyprexa (Lilly),  Seroquel (AstraZeneca), and Risperdal (Johnson & Johnson) are the top 3 atypical antipsychotics - medicines less likely to cause side effects, such as tremors, than haloperidol, an older psychiatric drug.  Studies linking these drugs to weight gain and diabetes prompted the FDA to require warnings to doctors in 2003 and 2004.

Alaska is suing to recover money it claims it had to pay for Medicaid patients who suffered serious health problems after taking Zyprexa. The claim is that Lilly did not adequately disclose that using the drug, could lead to severe obesity, elevated blood sugar and diabetes.

Lilly claims that it met Food and Drug Administration labeling requirements; that  Zyprexa has helped 23 million people; and despite filing the lawsuit two years ago, Alaska has not restricted the use of Zyprexa and at times has sought court orders to administer the drug to Alaskans with mental illness.

Alaska is one of nine states suing Lilly over Zyprexa and the first go to trial. The others are Utah, Pennsylvania, West Virginia, Montana, Louisiana, New Mexico, Mississippi and South Carolina.
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JCohen1015
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« Reply #45 on: March 22, 2008, 09:29:56 PM »

New to BPD, previously misdiagnosed as MDD and BP II, mid-50s, meds notwithstanding, does an individual with BPD need therapy for life - very expensive - interested in experiences of others
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« Reply #46 on: April 16, 2008, 06:19:54 PM »

With my BPD my P-doc has prescribed to different types of anti-depressants and an anti- anxiety pill.  At times I feel overwhelmed as I have to take these meds at different times of the day.  I am not sure if it is the right meds.  They definitely helped bring me out of my depression and suicidal thoughts, but how will they help with the long term battle of my diagnosis?  I am also in therapy and understand that they help me with my communication of thoughts and feelings, but I don't feel like I am really getting to the root of the rest of my problems such as splitting and impulsive activities.
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« Reply #47 on: April 16, 2008, 06:51:34 PM »

I was on Resperadol, but I started lactating milk and it really scared me.  My P-doc took me off of it right away.  I am currently on Clonazepam, Remeron, and Effexor.  Sometimes Zoplicon if I can't sleep.
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« Reply #48 on: April 17, 2008, 08:40:38 AM »

I was on Resperadol, but I started lactating milk and it really scared me.  My P-doc took me off of it right away.  I am currently on Clonazepam, Remeron, and Effexor.  Sometimes Zoplicon if I can't sleep.

My BPD "friend" (quotes because it's not clear what that means right now) also takes a regimen of Resperadol, Clonazepam, Remeron, & Effexor.  For her, it's the best combination of meds she's tried (and there have been many attempts)--it really works well for her.
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Abigail
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« Reply #49 on: April 18, 2008, 04:16:54 PM »

Depends on the doctor and what other comorbidities are present.  Remeron is a sleeping aid, not necessarily just for BPD.  My husband who has BPD, takes Prozac and Tegretol on a daily basis and uses Haldol and Risperdal or Abilify on an as needed basis.  My daughter who also has BPD, but a different type than my husband, takes Prozac on a daily basis but does not need to take the Tegretol.  She also uses Haldol on an as needed basis.  She takes Remeron for sleep and Buspar for anxiety.  And they both take either Adderall or Vyvanse for their ADHD.

Prozac and Tegretol have been shown in research studies to help those with BPD.  The use of a low dose antipsychotic like Haldol has also been studied and found to be effective.

Our doctor explains that it is not just the medication, but the dosage, sequence and timing.  And all of the comorbidities need to be treated such as anxiety, PTSD, OCD, ADHD, etc, whichever are present.  His website at www.biologicalunhappiness.com explains more about BPD and how and why he treats it as he does.  He has had a lot of success with his treatment plan.
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« Reply #50 on: May 08, 2008, 05:03:30 PM »

There have been so many moments of clarity over the last two years that I am beginning to get used to a permanent look of "WOW" on my face.   Smiling (click to insert in post)  This is one of those moments.

I took my D6's father, whom I now heavily suspect is BPD (of the waif-ish variety), to the emergency room for a psych eval after he told me he wanted to kill himself after I ended the relationship.  That was one of the worst days of my life.  That's the beginning of this story and how it pertains to your question.

After he finally moved out, he told me that he had started seeing a therapist (something that he actively refused to do during the tenure of our relationship) AND a psychiatrist.     They put him on Prozac--perhaps Zoloft--and Seroquel.  Forgive me for being a little slow on the uptake here, but I just put two and two together.

I would describe what took place after he left our relationship as nothing less that him being euphoric.  I couldn't understand why he had such a HUGE change.  So huge that he actually quit counseling after four sessions (why in the hell is that the magic number?) and got married four months after he moved out to someone he knew at work.  He said to me "When you know it, you just know it."

How profound.   :Smiling (click to insert in post)

So, the question remains...how has it affected him?  Well, he certainly lost inhibitions, which is a good since he was completely agoraphobic, but very bad because less than a month after leaving our house this woman was sleeping in his bed with our child in the same room (he lived in a one-bedroom apartment).  Very confusing for our two-year-old girl.  He's still an asshat, still makes wacky accusations, and still tries to engage me in these constant pissing matches.  When I ignore him, it just gets worse.

So I guess my answer is this: medication+no therapy=bad.   
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Abigail
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« Reply #51 on: May 08, 2008, 08:34:58 PM »

Antipsychotics can work as part of the BPD treatment.  But success depends on more than just using antipsychotics.  Several medications are usually needed to effectively treat BPD, along with therapy that also includes some type of cognitive behavioral therapy. 

And you need to treat all of the comorbidities as well.

   Our doctor has found a successful treatment plan that has worked very well.  So well, in fact, that people have come from all over the world to see him for their BPD.  My husband is a totally different person because of the right treatment.  And I know several others who have had some dramatic changes as well. 

   When used correctly, with the right timing, the results can be rather amazing.  But again, it's a little more complicated than simply giving someone an antipsychotic. 

  Abigail
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« Reply #52 on: May 24, 2008, 12:59:09 PM »

My dBPDso takes risperdal, gabapentin, and prozac every day--I think risperdal is the anti-psychotic, but it could be the gabapentin. Anyway, the doses she takes keep her non-zombi-fied, and she has less psychotic behavior than she used to, though it still does happen sometimes. I can't imagine what she'd be like if she weren't on these meds. And at the same time, she's preparing to re-evaluate them, because ya never know, she could potentially be less symptomatic if the doses were changed or she switched or added one...

Peacebaby
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« Reply #53 on: June 04, 2008, 07:51:36 PM »

I've noticed that the person's BPD got way worse once they stop smoking marijuna. Is there any research on

marijuana and BPD? Or any other natural treatments? It seemed to be a better mood stablizer than anti-depressant/anxiety pills, without turning someone into a zombie like the pills do. But once they stopped the marijuana, their behavior became much worse physically, mentally and verbally. This continues to go on a year after they had stopped marijauna, which rules out it got worse due to THC withdrawl.
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« Reply #54 on: June 05, 2008, 10:35:55 AM »

There is an interesting article of the state of therapies and population studies on our new website that is still under construction.  BPD Resources on the Net

My limited understanding of the role of pharmaceuticals in BPD therapy is to stabalize the patient so that  talk therapy can be undertaken.  The real healing come out of explorations of the past as well as the use of behavioral modification methods such as CBT, DBT, Schema, Mentalization, etc.

The use of drugs alone, is not seen as very affective - it just takes the edge off.  Alcohol does the same for an alcoholic.  People affected with BPD are prone to drug abuse already.

Leland Heller has made numerous statements about using drugs to treat underlying conditions that could be exacerbating BPD - like thyroid defiencies, or clinical depression, etc.

Joel Paris.MD, made the comment below about the use of pharmaceuticals in the treatment of BPD per se' last January...

"The problem is that there is no science to support polypharmacy [use of single or multiple drugs], and it's probably bad for patients," he said at the meeting. "When you give patients with classical depression an antidepressant, they may be cured in a few weeks. But you never see that in patients with borderline personality. It might take the edge off, but patients never go into remission." Paris is a professor and chair of the Department of Psychiatry at McGill University in Montreal and editor in chief of the Canadian Journal of Psychiatry. He is also a past president of the Association for Research in Personality Disorders.

If the pharmaceuticals have not yet been studied - it's probably a fair guess that herbs and alternatives have not yet been studied either.

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« Reply #55 on: June 12, 2008, 07:40:23 PM »

Well in my experience my ex-BPD would not rage as often when she was stoned...  Smiling (click to insert in post)

I doubt it would help on a long-term basis to get the "edge" off.
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« Reply #56 on: June 14, 2008, 04:51:07 PM »

I have to say that my husband is much cooler to be around when he's stoned...he's always been that way for the 11 years I have known him.  As a matter of fact, I know that I have enabled him to keep on smoking because it keeps the peace for the most part around here.   When he doesn't have any, he becomes a real ass and no one wants to be around him.  That's when the real BPD traits come out...

So, maybe it's different in everyone...

C
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« Reply #57 on: June 16, 2008, 11:46:56 AM »

My dBPDso takes meds for her condition, but she also self-medicates with mary jane on a regular basis. In general, it works for her--when she's feeling really anxious or depressed or she can't stop thinking in a way that makes her feel really negative, smoking some weed will calm her, get her focused on something other than her negative thought process, and then put her in a place where she can either calmly talk about what's bothering her, or say she'll think about it later when she's calm and sober 'cause in that moment she's feeling too good to ruin it.

At the same time, it's weed, so it not only takes the edge off her symptoms, it takes the edge off her drive to do stuff. But for now, I'd rather see her calm and not incredibly productive, than more productive and totally stressed out of her mind to the point of madness.

Smoking weed also takes the edge off being around her sometimes! 

Peacebaby
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« Reply #58 on: June 19, 2008, 02:37:45 PM »

this post couldn't be more true to my own experience with my gf. sometimes, i think that it's the most effective medication she's taking.

My dBPDso takes meds for her condition, but she also self-medicates with mary jane on a regular basis. In general, it works for her--when she's feeling really anxious or depressed or she can't stop thinking in a way that makes her feel really negative, smoking some weed will calm her, get her focused on something other than her negative thought process, and then put her in a place where she can either calmly talk about what's bothering her, or say she'll think about it later when she's calm and sober 'cause in that moment she's feeling too good to ruin it.

At the same time, it's weed, so it not only takes the edge off her symptoms, it takes the edge off her drive to do stuff. But for now, I'd rather see her calm and not incredibly productive, than more productive and totally stressed out of her mind to the point of madness.

Smoking weed also takes the edge off being around her sometimes! 

Peacebaby

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« Reply #59 on: July 13, 2008, 12:32:27 AM »

Cannabis can make some people more mellow while on it, and others more agitated. Of those who react well to it I have seen habitual use makes them really cranky when they stop smoking because they have lost their ability to cope with things.

I don't really think THC would help BPD. On the other hand another illegal drug called MDMA is apparently having some pretty profound (initial) results when used in psychotherapy for PTSD. I think there have been a few articles about this (Washington Post is one)
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