Q. I am a nurse/therapist working with a client who is on Ritalin, Zyprexa-small dose, Klonopin, Benadryl, Serax , Trazodone combination who seems fearful of taking the Zyprexa. Have you seen success with BPD with Zyprexa. I feel she needs it and does not do well when she misses this ingredient.

  A. I would imagine it would work. Personally, I prefer Serzone as a 5-HT2 blocker over an atypical. Particularly if you have her on Ritalin (or any other stimulant) since this will reverse the D2 antagonism of the atypical anyhow.

That said, I know a number of doctors that utilize atypical antipsychotics (Zyprexa, Risperdal, Clozapine, and Seroquel) in their BPD patients with good results. The mental slowing and weight gain are problems, so I avoid them if I can.