Question:
Dear Doctor,
I have been taking like 4 different meds
to treat my BPD and it's not
working. We've been going at this for
years now. I take Effexor, Seroquel, Lexapro and
Topamax. Should I be trying something
different? They are all used to treat mood and self
mutilation.
Dr. Heller's Answer:
1) Effexor (venlafaxine): rarely works.
Very high doses are needed, approximately 450-600mg
daily.
2) Seroquel (quetiapine): helps with
severe sleep disorders. Rarely does much for the BPD.
3) Lexapro (escitalopram): sometimes works. All
SSRI antidepressants help some, but none
are close to Prozac (fluoxetine) for effectiveness.
4) Topamax (topiramate): helps for migraines,
but usually makes the BPD worse.
The best medications for the BPD continue to be
the combination of Prozac (fluoxetine) with
Tegretol (carbamazepine). Depakote is 2nd
to Tegretol, and Lamictal third. As needed
antipsychotics like Haldol (haloperidol),
Zyprexa (olanzapine) and Risperdal (risperidone) are
also effective.
Individuals with the BPD usually have more
diagnoses than just the BPD. Treating all of them
comprehensively is crucial as everything you
have wrong with you makes everything else you
have wrong with you worse.
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