Q. I am 33 yr. female diagnosed with BPD. I feel like I have finally found the right doctor after twenty years of being depressed and suicidal. I can not believe the difference the right meds can make! I have several questions.
1. I have noticed in the past and recently that things don't feel "solid" to me. For example, if I put my hand down on a table, the table seems like it is "wavy" almost like rubber. Additionally, some times the room will seem to "tilt" until I shake my head. Are these temporal lobe seizures?
2. I was treated with Prozac for five years, then it seemed no longer effective. My treatment now with Effexor, Tegretol, and Navane seems to leave me feeling better for a longer period of time. Do meds lose their effectiveness and need to be changed periodically?
3. I know you emphasize retraining and therapy in addition to meds. Is it ever necessary to medicate BPD for life? What is the average time after meds are right that a motivated BPD can expect to learn better responses to stress and thus less need for medication?
4. If a crisis occurs in a properly medicated BPD that seems nearly equivalent to crisis prior to correct medical treatment, is this a medical or therapeutic issue? i.e. How does one know whether to call the therapist or the doctor?
A. 1) While temporal lobe seizures may not be present in your case, temporal lobe dysfunction can clearly cause these symptoms.
2) In my experience, no, the meds do not stop working. Other things happen. The problem with the BPD is that when dysphoria becomes chronic it is assumed that Prozac has stopped working when in reality additional things are wrong.
3) Whether meds are needed for life or not depends upon the individual. The as needed medications for acute dysphoria - I prefer haloperidol - will be NEEDED less over time when stress is INTERPRETED differently. Many people seem to heal, like a stroke patient, when life has changed dramatically.
4) I view it's a medical problem first, although the therapist may be necessary as well. I give an instruction sheet to my patients explaining when and how to use as needed medications.