Q. 1. I have a major impulse control problem. I was diagnosed with BPD about 8 years ago. I spend A LOT of money (usually only when I'm in a good mood) and at other times, I am constantly looking for ways to make people want me, to boost my self esteem I guess. I am in love with a wonderful man and all these games and the lies are destroying our relationship. I've never cheated on him, I guess it's just the thrill of what I can get away with. It's so hard for me to stop. Are there any easy solutions?
2. I would like to have another baby but I am taking 1500mgs of Depakote and 500mg of Effexor a day. This medication and these levels took a long time to figure out and I know that Depakote causes birth defects. Any solutions to this one?
A. There are no easy answers or this web site would not be visited very much. I would suggest getting off the Depakote if you want to have a baby, and staying on the Effexor. The former is bad for fetuses, the latter seems fairly safe. Since you are on 500 mg/day of Effexor, I would also suggest using the XR formulation of Effexor at 450-600 mg/day. It has half as many side effects and can be taken once daily. Effexor dosage is determined as follows. Take it until carbohydrate craving goes away and/or any somatic complaints (PMS, irritable bowel, fibromyalgia, headaches, migraines, etc) go away. Use the 450 mg XR for one week. If you still have no diminution in somatic complaints or sweet tooth, go to 600. Cigarette smokers need more than nonsmokers. Smoking is bad for the fetus, so stop if you can (if you are a smoker).