Why Do Medications Only Work On Some Of The Symptoms?

QUESTION:

Dear Dr. Heller,

I am a 31 yr old female, diagnosed w/ BPD and depression.  For many years I have been on/off Prozac and BuSpar.  They seemed to work great but then would abruptly end after I hit the maximum dosage.

I now have a new Dr.  who has prescribed Effexor.  I am currently taking 150mg a day for about 2 months now.  The Effexor works wonders on the depression.  I haven't had a recurring episode yet, even though I suffer from a more than moderate case of PMS.  I also seem to suffer from an intense physical reaction when encountering stressful situations.  It can be described as a flight or fight feeling.  This can be very debilitating at times.

My current physician does not believe in poly pharmacy.  So my question is this, is there a medication that seems to work with the BPD symptoms and also gets a handle on extreme anxiety?  I tried mentioning Xanax put he didn't take to this idea.

My physician is a family doctor.  Should I be seeing a psychiatrist instead?  I was diagnosed originally by a psychiatrist, but due to insurance reasons could no longer see her.

Any help would be appreciated.

ANSWER:

I suspect the problem with your medication regimen is you don't have anything to take when you are experiencing dysphoria (anxiety, rage, depression and despair).  I've been disappointed in Effexor for the BPD, although some practitioners report good results with very high doses in the 450 to 600mg per day range.

I make all the diagnoses present on my screening test ( http://www.BiologicalUnhappiness.com/screen.htm) and treat them comprehensively.

There's a lot of information in the BPD section ( http://www.BiologicalUnhappiness.com/bpd.htm) including an article for primary care physicians ( http://www.BiologicalUnhappiness.com/abstract.htm) and an update ( http://www.BiologicalUnhappiness.com/update.htm).