Q. I am a 58 year old physically healthy woman who has been in therapy 23 years. I am a smoker and about 40 lbs. overweight. Until last month, I thought my diagnosis was depression. I feel like a failure because although I have been on numerous medication, am currently seeing my third therapist, have been evaluated at John Hopkins and a private psychopharmacologist, I continue to struggle with serious emotional problems. I work very hard to block my suicidal thinking (no attempts but only for the sake of my family) and powerful feelings of hopelessness and an inability to find meaning in my life. I no longer go to church because I feel abandoned by God. My feelings build to a rage which has left me frightened to push myself "too hard". I work part time, have earned a MSN, and raised a healthy family. My children and grandchildren bring me great joy but I am overwhelmed with fear trying to ensure that I control my anxiety around them. I have the emotional support of my husband of 37 years, but I have very serious negativity concerning sexuality. This is a serious problem.
I have been on numerous medications over the years including Prozac, Mao's, Lithium, etc.. In the last 3 1/2 years with my current therapist, I have taken Prozac 20 mg. qid, Zoloft 100 mg. bid, Effexor XR 150 mg. q.am (dc'd because of headache), Buspar 5 mg. bid (each individually). I was started on Depakote 250 mg. qd and Haloperidone 1 mg. PRN on 2/9/00, I have little trust or hope left.
A. I can tell you for a fact that your illness is biological. Heck, you want to feel good, and everything else in your life you can enjoy (your grandchildren and children) you do. So, if you could feel better by thinking different, you would. Particularly since you already change everything else in your life under volitional control. For example, coat in winter, shorts in summer.
I have ethical and legal concerns about commenting on your prior treatment, but would refer you (and your psychopharmacologist) to my book chapter or articles on pharmacotherapy of borderline personality disorder (in my CV on this website). As an example, you may need more Zoloft. Our data suggested that you need to be on enough to have a serum level of 180 ng/ml between 6 and 8 hours after taking the medication. Most of our folks are on between 300 and 400 mg daily. You can also take the Zoloft all at one time for a number of reasons, not the least of which is convenience. Sorry for being so circumspect, but it is appropriate for you to talk to your doctor. DiPaulo at Hopkins has done a lot of good work, and you may wish to contact his office for another opinion.
