Q. I have been a nurse for 15 years. When I was married and having difficulty maintaining working relationships as well as family relationships I began seeing the same Psychiatrist that my husband was seeing. This Psychiatrist is one of few in our small town and my ex-husband thought well of her as he saw her as a patient and as an associate. He is also a Doctor, working in the mental health field.
Because I am a nurse I told her I was concerned that I may be bi-polar when I first met with her. I received no testing. I did receive a diagnosis of bi-polar II. I have been on different medications and have been taken off SSRI's because they do appear to cause me to cycle. I am currently on Topamax 200mg qhs
After my latest psuedo-suicide attempt (oct. 2000) I asked the Psychiatrist if I am also BPD, due to some of the comments I had caught myself making. She confirmed my suspicions.
Since I have been diagnosed with BPD I have been able to get my self into a DBT program and do think I am making some progress.
I have been seeing this Doctor for three years now. She has told me that if I drink she will refuse to treat me. I am an alcoholic. I do drink. There are no other Doctor's with openings in town right now. I am involved with the program for recovering nurses and they require that I continue to see this Doctor.
I also have a hx of sub dural hematoma treated with craniotomy and no complications. I am a smoker (tobacco no street drugs). And I am fluffy 225# at 5'55"
I also take Levoxyl 100mcg qd for hypotyroidism following a brief interaction with Lithium.
My question; What to do? I do feel hopeless. thanks for any suggestions you may have.
A. Your history is well delineated in your letter, but there is still not enough data to give you a good answer. If you have little to no obsessive compulsive symptoms, Serzone would be worth a try. Since it works similarly to Risperdal, Seroquel, Zyprexa, etc., it has little to no chance of making you cycle. Usually we get folks to 500 to 750 mg hs over a few weeks.
If you are obsessive, I prefer using Effexor XR until carbohydrate craving goes away and you start to lose weight. Hopefully, the Topamax will prevent cycling. I have cases where folks do cycle on Effexor. Sometimes getting to the correct dosage alleviates this, sometimes it does not. Thus, you might cycle on 150 or 300 mg Effexor XR, but not 450. Obviously there is some risk involved here. One male patient in particular comes to mind that cycled on all the antidepressant medications except for Luvox. So even if this happens with Effexor and Zoloft, it might not with Luvox.
As far as antiepileptics-Topamax, Lamictal, etc., I have recently had some good luck with Gabitril. It seems to have better antidepressant properties than the others for a number of folks.
Finally, the new medication by Pfizer, Geodon (formerly Zeldox) is a pretty good antipsychotic with little weight gain associated with its use. It has only been out a few weeks, so it is a bit early to give you any data on its use in BPD, albeit there is good data supporting its use in BPI disorder.