Q. Are medications needed for BPD? I've have tried Paxil off and on with no relief. I'm also having difficulty with carbohydrate cravings so I don't take it regularly. I'm afraid of gaining weight.

A. Medications, like therapy, are an option to get well. My own belief is that BPD is a purely physical illness with behavioral sequelae. Just like when you break a bone (physical), you get atrophy of muscle (behavioral sequelae). Without the right meds, DBT is not going to get you where you need to be. Actually, therapy is not nearly as good and often worse than nothing in a physical illness.

If Paxil had bad side effects, that is pretty common. It has in my opinion, without question, the most side effects and lowest efficacy of any of the SSRIs. Zoloft (200-400 mg/day), Prozac (80 mg/day) and Celexa (60-80 mg/day) are all a lot better. None of these may be right for you, but dry mouth will not likely be an issue. Serzone is also pretty good if you do not have obsessive compulsive disorder. It is best as an all bedtime dosage, and most people who respond do so between 500 and 750 mg at bedtime. Effexor XR has the highest efficacy rate, but a touch more side effects because of its broad spectrum of efficacy. In all cases, titrate dosage of medication until carbohydrate craving/sweet tooth resolves.

Try all the medications before bailing out. Therapy alone will not work very well.