Question:
Hello,
My 18 year old daughter has just been
diagnosed with borderline personality disorder. She
was on Prozac and that did not help--she recently
attempted suicide.
A psychiatrist is seeing her now and has taken her
off Prozac and she is currently on no meds. Is that
advisable?
Thank you,
Can't Sleep Mom
Dr. Heller's Answer:
While some individuals with the BPD can do well
after they've successfully taken medication for a
while and they are no longer under stress, one with
the BPD doing poorly should be on medication.
Prozac (fluoxetine) alone is not enough as it only
works for part of the problem. The right Prozac
(fluoxetine) dose will stop the unprovoked mood
swings, chronic anger and irritability, emptiness
and boredom. It will also reduce the frequency of
dysphoric episodes (that can include suicidal
behavior), but it will not reduce the intensity of
those episodes. Tegretol and/or short term Zyprexa
are in my experience the best emergency options.
If the patient is already taking Prozac and
Tegretol, one dose of Risperdal (usually 3mg) will
stop BPD dysphoria in 24 hours. Once stabilized
with Prozac and Tegretol, Haldol (haloperidol) will
usually work in 10 minutes whenever the individual
experiences dysphoria (anxiety, rage, depression
and despair).
While practitioners may disagree on how to treat
the BPD, the scientific literature and
recommendations of some journals and societies
definitely back the use of medication for the BPD.
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