Q. I've been on Fluoxetine (Prozac) for close on 1 year now, my dosage gradually increasing from 20mg to the current level of 60mg. My Doctor advises side effects set in above 60mg and will not consider a higher dosage. In the past I have had particular problems with dissociative symptoms such as memory loss and derealization as well as others such as self injury to relieve dysphoria, inappropriate anger and rages. While these symptoms have lessened under medication I am still having problems with visual hallucinations and transient paranoid ideation, both of which cast a shadow over the rest of my day once gone. My Doctor has prescribed 50mg of Thiorizadine to be taken on a PRN basis to alleviate these problems.
1) Is Thiorizadine (Mellaril) an appropriate medication for BPD sufferers?
2) If so, what dosage is generally recommended?
3) Are there any alternatives (a monthly low dosage intramuscular injection of a depot drug like flupenthixol has also been mooted as a possibility)?

A. The literature shows that Thiorizadine is not appropriate for folks with BPD. I am not sure what the problem with going to 80 mg of Prozac is, since that will alleviate the need for the Thiorizadine most likely. Paul Soloff did studies with haloperidol, a stronger medicine than Thiorizadine but similar, and it helped for a few weeks. It then did not do anything, and can cause tardive dyskinesia. The side effects of Thiorizadine are hellacious compared to those of Prozac, so your doctors reasoning is lost on me. We have done a double blind placebo controlled trial that unequivocally shows 80 mg/day of Prozac works. This type of trial is the gold standard.

If you need to be on an anti psychotic, Risperdal or Seroquel would make more sense from a biological perspective.