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 it’s far more common for
individuals with bipolar to have the BPD than those with
BPD to have bipolar. Either way it’s not unusual,
nor is it that difficult to treat. It’s 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
doesn’t 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, I’ll 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://www.BiologicalUnhappiness.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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