QUESTION:

Dear Dr. Heller,

I think it is possible that I am biologically depressed.  But I am on Paxil 20 mg daily (for a few months now which seemed to be working), and am seeing a therapist and am looking for a support group. But yesterday I had suicidal thoughts, and now have this unbelievable pain and anguish. I could not work today, there was no way of concentrating. I feel despondent although I am working so hard to try and help myself. Any ideas, suggestions, am I doing enough? I feel lifeless and empty.

ANSWER:

I highly recommend you review the BPD diagnosis. I have an entire section on the BPD and most ask the doctor questions are related to the BPD. You likely have dysphoria (anxiety, rage, depression and despair), which is a completely different form of depression that needs an epilepsy medication like Tegretol, or a low dose neuroleptic such as Haldol. The How I Treat the BPD and Why section explains my rationale.

Making all the diagnoses and treating them comprehensively is crucial. The screening test I use for my patients will likely give you some clues. The dysphoria instruction sheet and medication sheet I give my patients is very helpful to many people - particularly with stress symptoms which must be aggressively treated.

Retraining the brain is so crucial, but rarely works when the medications aren’t correct. I admire that you’re trying this, and you’ll be stunned how great you can do. My goals are very lofty but definitely achievable. The testimonials may be of help in getting hope - and hope is as important as any other factor.

I hope this helped.