Am I a BPD Who Just Can't Take Antidepressants?

QUESTION:

Hello Dr. Heller!

Thank you for such a helpful Website.  My problem is that when I take the various antidepressants prescribed to cure BPD I feel myself wind up as tight as a drum and then am prone to almost blind rages and am intensely uncomfortable.

Could this reaction mean that my serotonin level is adequate to begin with and does not need manipulation?

Do all BPD people (I definitely am a textbook case) have a faulty serotonin level?

Can you have BPD and not be helped by antidepressants?

I was recently diagnosed with hypothyroidism.  I was encouraged that you said 1 out of 3 BPD's have this.  The initial small dose of Synthroid is helping.  But again the entire pill caused a feeling of overstimulation that began to border on this "hypertensive reaction" to stimulant-like medications (if only as regarding my system's perception of them).

Lastly, could a very low thyroid cause inability to tolerate antidepressant medication or process it properly?

My life depends on your answers as the borderline reactions to 12 step groups and "peopled" workplaces is causing me to live an increasingly restricted lifestyle, and I am losing my will to go on.

Thank you for answering my letter.

ANSWER:

In my opinion, the BPD is damage to the brain's glial cells.  In addition to its serotonin effects, Prozac improves glial cell function.  I'm highly suspicious borderlines are either low on serotonin or have a problem utilizing the serotonin they have.

The usual reason for your problem is the cognitive generalized anxiety disorder, where the serotonin 1A receptor is overactive.  SSRI's increase serotonin and make the anxiety worse.  BuSpar is the answer here.  It will lower the overactivity and make it possible to take Prozac.  I go into this at length in " Biological Unhappiness."

Thyroid can stimulate the brain, increasing the GAD.