Q. I've been treated with many different types of antidepressants. The tricyclics did not help, Paxil gave me insomnia and extreme irritability. Prozac and Zoloft did not help my depression and made me irritable. Finally, I was put on Nardil and Klonopin and had a great deal of relief. I remained on the latter two for about five years. I tried to go off the Nardil several times because of weight gain, but I had to get back on because I just felt so horrible off of it. Eventually, I started having real bad insomnia and bruxism. I was hospitalized and weaned off these meds and was given Remeron and Depakote. I feel worse than I did before. At least on the Nardil I was much less irritable. These days, I sleep well, but I'm cranky and depressed most of the time. Every little thing gets on my nerves. I'm also gaining weight. I have always had problems with compulsive over-eating and this medication I'm taking isn't helping with that at all.
I was diagnosed with borderline personality disorder and generalized anxiety disorder in 1994. Four months ago I was diagnosed with bipolar disorder ll. I am a 34 year-old female. Any insight you have will be much appreciated.
A. I will do the easy part of your question first. Most folks with Borderline Personality Disorder also meet criteria for Bipolar II disorder. No insurance company will pay for inpatient hospitalization for borderline personality disorder, so we call them BPIIs to get paid. On the positive side of this cynical, but true statement, the advent of BPII indicates that folks are now looking at borderline PD for the biological disorder it is.
Don Klein's group did outstanding work on borderlines in the early 1960's (and still), and MAOIs work well, but have all the side effects to which you refer. Weight gain is a huge problem, no pun intended. You have likely read many from the other letters, and I would suggest the following.
1. If you have a good deal of money or live near the Canadian border, you
can get
on a reversible MAOI called Mannerex (meclobimide). It has all the
advantages of
an MAOI without the weight gain, dietary restrictions, drug interactions,
etc. The
demographics do not make this reasonable for a lot of people, but it is
great if
you can do it.
2. Get on something else. If you feel poorly, get on something that works
better. Serzone and Effexor are two options for you. The former has no weight
gain problems, but does not work well if you have OCD. The latter is great
for weight loss initially, albeit some may come back later.
