Q. My 13 year old son, who has no environmental contributing factors, has been battling depression and I have recently discovered he is self-injuring, as well. He was recently started on Tegretol for treatment of self-injury and severe mood disorder. He had been diagnosed with rolandic epilepsy as a pre-teen (his only seizures occurred at ages 8 and 10). Could that be a possible explanation for the mood disorder and self-injuring now?

A. I am not aware of any cases of self-injury arising from an epileptic problem. Therefore, I doubt his self-injury is from the epilepsy. Self-injury is usually associated with borderline personality disorder (BPD), but not always. Tegretol is a decent treatment, since it covers both disorders. Rex Cowdry and David Gardner showed Tegretol to be the best drug available for BPD in the pre-SSRI days. The bad thing about Tegretol is that many individuals with BPD develop a pretty bad depression on Tegretol (this was also published by Cowdry and Gardner). Using Serzone, Effexor XR or any of the SSRIs would probably be worth a try in your son. The choice of which drug is based on presenting symptoms. None of them are particularly epileptogenic.