Q. I was diagnosed with BPD two years ago and have been treated for clinical depression and PTSD since that time. Hospitalized five times in that two years will focus on depression and PTSD. Was not aware of the BPD dx until March of this year when I was committed to the State Hospital. The psychologist sat me down and very frankly told me about the dx and what it means. He was of the old school of thinking and informed me that it was hopeless- I would never be able to overcome the side effects. I chose not to believe him and was released from the hospital after three weeks- was to have been three months. His assistant got me some info off of the internet and in it was the suggestion that the patient come up with a coping plan for each of the criteria relating to her. I am an RN and so used the model of a patient care plan to come up with a personal coping plan of my own. Was very encouraged and felt pretty confident.
During that time I was on Celexa 40mg/BID. It had been effective in controlling the depression for about a year. BuSpar 15mg/BID effectively controlled the anxiety component. My doctor had added Desyrel 150mg/HS to augment the Celexa about three months prior to that hospitalization. Seemed to be working very well. About a month ago, the therapist assigned to me after discharge from the State Hospital began to question the effectiveness of the meds. I was having a particularly difficult time with the depression and the anxiety. The psychiatrist stopped the Celexa and tried me on another anti-depressive which made me feel like I was going to jump out of my skin- could not tolerate it even for just three weeks. He stopped that med (I am sorry I cannot recall the name of it- guess I blocked it!) and told me that since I was already on the Desyrel and we knew I could tolerate it that we would just double the dose and use that as the primary anti-depressant. Did that and by the next week was feeling less anxious, fearful and depressed. My t even commented on how that was the first time he had seen me when I wasn't agitated. I have not felt as good as I did on the Celexa at its peak, but was it seemed to be working okay. His nurse told me to give it more time. I do dread having to experiment with other drugs- it is so difficult to endure all the side effects and seems to have no end in sight in the midst of it!
A month ago my medical doctor blew up at me. Really razed me pretty harshly. I began to tear up then cry sitting on the exam table and when he saw that he only got louder. By the time I left I was hysterical. One of the facts the psychologist at the State Hospital shared with me was that we were very difficult and obnoxious and that I would find it very hard finding a doctor willing to treat me. That has echoed in my ears ever since Dr. berated me so, even though my therapist explained to me that it was a totally inappropriate reaction.
I was doing really good up until that time emotionally. But I seemed to have let it knock me off balance and cannot seem to get it back. I am a diabetic and have lost 52lbs since last Aug to avoid insulin, incredible will power that seems to have just evaporated. Thought I had the BPD beat until a friend of mine pointed out the classic behavior I have been exhibiting this past weekend.
I know there is a drug for the depression and one for the anxiety. Is there one for the hopelessness and discouragement I feel right now? Several times I have wished this past week that I had not survived the gallbladder surgery I had six days ago. That kind of thinking really scares me. I just want to give up. I have tried so hard and felt I really had a hold on it and now I realize I was only kidding myself. I am so tired of putting my family through this *ell! I have nothing left to fight with. I have a husband and three children and I cannot understand how I can feel this way when God has given me so much. I cannot stop crying when I am alone. Does this mean that the Desyrel is not working optimally? I am simply so discouraged that I just want to curl up and hide from the world.
If there is no medicine for that, then can you please suggest some workbook or literature that would be helpful. Have read your book and it was immensely helpful. Also read, Life At the Border, Imbroglio, and Eclipses. I have exhaustively researched everything I can find on the net. Please, Dr. Markovitz, I need help from someone who truly understands this illness. I can't let myself give up- please help me.
A. Without being too simplistic, there are a number of medication suggestions in the many letters that make up this site. If the Celexa worked best, go back to it. If not, consider Serzone (500 to 600 mg at bedtime) which is similar to the Trazodone but does not have weight gain or sedation as a side effect, or Effexor XR as 300 to 450 mg in the AM. Zoloft, Celexa, Prozac, Luvox and Paxil are all pretty much the same (they are all SRIs). One of the five, however, may fit better than the others. Average dosage of Zoloft is 300 mg daily (range 200-600) and Prozac is best at 80 mg/day or more.
