This is
the instruction sheet I give to my patients with the Borderline Personality Disorder. It
is for information purposes only.
The borderline personality disorder (BPD) is a devastating neurological illness that
causes enormous psychological damage, and usually destroys lives. The suicide risk is
approximately 9%. The risks of substance abuse, auto and work accidents, divorces, AIDS,
child and spousal abuse, and early death are high enough to take this disorder very
seriously. Treatment includes medication, counseling, and "retraining the
brain." Medication is virtually always needed, and can make a profound difference.
- SSRI's: The
main symptoms treated by SSRI's include: mood swings, chronic anger, emptiness, boredom,
and depression. Prozac has been the most thoroughly studied and is very effective.
Alternatives include Paxil and Effexor - choosing these medicines instead of Prozac would
be for other illnesses and/or side effects. Dosage increases usually are effective very
quickly, often in one day. Dosage increases or decreases should not be more often than
every week, unless directed to do so by a physician. Side effects can include shakiness,
fatigue, stimulation, insomnia, sleepiness, or nausea.
- NEUROLEPTICS:
Excess production and/or increased sensitivity to the brain chemical "dopamine"
seems to be a major cause of rage, anxiety, despair, self-destructive thoughts and
impulses, weird body sensations, paranoid thoughts, impulsive behavior and dysphoria
(anxiety, rage, depression and despair). There are many drugs in this class, but Haldol
appears to be the best - it works quickly, with minimal side effects and in low doses
(generics usually don't work). The antihistamine Benadryl will reverse a potential side
effect where the muscles go into spasm - notify your physician(s) should this happen. Long
term chronic use, especially in the elderly and/or with high doses, can cause permanent
side effects impairing muscle control. If daily use is needed for a long time, additional
medication is likely necessary.
Neuroleptics like Haldol should be used whenever anger, stress, paranoia, rage, or
self-destructive impulses are present. They give a BPD patient control over their illness,
and can be taken before stressful events to prevent problems. It is far better to take the
medicine when in doubt than suffering the consequences of losing control. For severe
symptoms caused by temporary stress, Risperdal is the strongest and most effective
emergency medicine to take as needed, but usually causes profound sleepiness.
- EPILEPSY
DRUGS: The most severe BPD symptoms are likely a form of epilepsy and include
"dissociation" (unreality, body parts going numb, deja vu, etc.) and chronic
"dysphoria" (anxiety, rage, depression and despair). When neuroleptics like
Haldol are ineffective, epilepsy drugs like Tegretol (carbamazepine),
Neurontin, and
Depakote can often stop the symptoms in hours. Depakote (valproic acid) can also control
the bipolar disorder. Blood levels are very important to monitor, as are liver blood tests
and blood counts. Patients who are well educated about the disorder and it's treatment can
use extra doses when needed, however the risk of side effects (especially grogginess) is
increased.
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