Q. Dear Dr. Heller:
I've been diagnosed with major depression for over 20 year and just recently with BPD. I was shocked to see how many DSM IV criteria I met for BPD. I am currently taking Prozac, Buspar, Thorazine, Vistaril and trazodone (I also suffer from trichotillomania). I've been on just about everything else (all the anti-depressants, most of the anti-anxieties, zyprexa, anafranil) and this combination seems to be the best regarding side effects and just plain weird consequences. Are you familiar with any or all of these drugs used together or separately for treating BPD?
A. I suspect you have many diagnoses - most borderlines do.
If you're experiencing chronic dysphoria (anxiety, rage, depression, despair) - particularly with dissociative symptoms such as unreality and deja vu - you will likely experience a profound improvement in just a few hours with the addition of tegretol. There is literature from NIMH in 1986 about the use of tegretol in the BPD. I've found it to be remarkably effective with Prozac when needed.
The dose of Prozac is also extremely important. If inappropriate moodiness, chronic anger, emptiness or everything feeling like it's life and death are present, higher Prozac doses may have a profound effect. If you need Tegretol, the higher doses of Prozac will likely not help until you are taking tegretol and the chronic dysphoria is gone.
In my experience, Thorazine, Vistaril, trazodone (used most for sleep), anxiety medications like valium, and anafranil are rarely helpful for the BPD.
As with everyone else, all your diagnoses need to be made and effectively treated for your BPD to be successfully treated.