Q. I am a 23 yr male living in Canada, and I exhibit the following symptoms:
1. Frantic efforts to avoid real/imagined abandonment.
2. Unstable and intensive interpersonal relationships
3. Unstable self-image
4. Binge eating, excessive spending and sex
5. Intensive episodic irritability, anxiety
6. Chronic feeling of emptiness
7. Chronic fatigue (not wanting to do anything)

I was told Parnate (Tranylcypromine) might be useful, as it gives a very useful "go power" to treat chronic fatigue and emptiness; but I am very worried of high demand, almost impossible, diet restriction (i.e.: no cheese, alcohol and overnight meat).

1. For BPD, are there any drugs offering similar motivation-force (stimulation?) but without the strict diet restrictions?

2. If not, assuming cost is not a factor for now, does Effexor XR work better than Serzone? What is a good dosage anyway (23 6'2" 250#)?

  A. This site has a number of letters detailing drug treatment. Look over them for alternatives to Parnate or Nardil. The latter two medications do work, but no better than SRIs and not nearly as well from a side effect standpoint.

As far as which medication is best, there is no such thing. For many patients, Tegretol works best. For others lithium. For others SRIs, and so on. Serzone is very good if you have no OCD, but not as good if you do. Long-term, nefazodone has fewer side effects and is significantly cheaper. Effexor, however, works in more people. If you took 100 people with BPD, Effexor would work in more of them to reduce the illness than Serzone. Which is best for you depends on which one fits best.