Q. I was diagnosed with BPD around seven years ago, and have exhibited all of the classic symptoms, from eating disorders to self-injury to identity problems. About a year ago I was hospitalized, and the psychiatrist I was assigned to began treating me for what he thought was Bipolar II.
One of the medications he prescribed for me, Tegretol, has literally changed my life; my body feels quiet for the first time in my life.
After reading your answers on this board I asked my psychiatrist to raise my dose of Effexor from 225 mg to 450 mg; he has, and it is working beautifully.
In addition to the Tegretol (200 mg at night) and Effexor (450 mg in the morning) I take Revia (50 mg) and Zyprexa (2.5 mg).
Though these medications have transformed me, I have gained over 70 pounds. I have been dieting stringently and have not been able to shed more than 5 pounds. The only symptom that remains, besides some mood problems around PMS time, is my inability/refusal to keep where I live clean. I live in total filth, though no one would know from looking at me. It has been this way for a number of months, and I cannot get my place clean. This is not like me, and I am beginning to feel desperate.
Do you have a suggestion? Do you think this is a behavior problem, rather than something that may be solvable pharmacologically? Do you have a suggestion as to how I can go about losing this weight?
A. Weight gain is an issue in most folks with BPD. Do not make any changes in your medicine without consulting with your doctor. The weight gain can be from being on the Effexor too long and down-regulating serotonin receptors responsible for satiety, Zyprexa may be the culprit or it could just be the illness. I have had pretty good luck with the medication Provigil in folks like you. Its only indication is for narcolepsy, but it is a phenomenal good augmenter of antidepressants. The Provigil is a synthetic dopamine, so it works a bit like Ritalin or Adderoll, but does not have shakiness or a high feeling. It just gives you alertness and better focus, and usually better energy. It is grossly expensive, but does some good things. It causes weight loss in half the folks who use it, yet this is not a side effect of the Provigil in the package insert. You can always use phentermine, or Wellbutrin as an add on, but the former is tightly controlled and the latter does not work as often as we would like.
Since you are doing so well, I would not take away anything you are on. There are some new Zyprexa-like medicines coming out soon (Pfizer has one) that do not cause weight gain, so if the Provigil does not work, you may want to give it a try.
