Paul Markovitz M.D., Ph.D. Chat Conference about Borderline Personality Disorder- 6/28/00

Page Two

<TimLPN> or do other disorders self mutilate?? 
<Pattybpd> If someone cuts, does that mean they have the BPD "more severely," or does it meant that there are different "types" of BPD? 
<DrM> Cutting usually indicates BPD. Surprisingly, it was the best predictor of a good outcome. You did better with it 
<christy74> What causes me not to even realize that I am cutting on myself until all is done? 
<bingle1> what do you mean did better with cutting? 
<DrM> You may depersonalize when you cut. Or maybe it just feels so good, you do it. Like scratching an itch. 
<lance37> but I’m serious Dr.M when I take heroin I don't feel anxious or different from others I have drive and I really feel normal like all my symptoms are gone and one little bag lasts for 2 or 3 days <Freaked> I burn to punish myself 
<DrM> Cutters have the best outcome with medications by a ton. 
<Freaked> and then pick and scratch at them when there healing to relive it. 
<Pattybpd> Very interesting. 
<bingle1> so perhaps I should start cutting..lol 
<DrM> As far as heroin, you might want to think about getting on a substance P antagonist when available. There are trials now 
<DrM> Never cut if you can avoid it 
<weepippo> I take Serzone and Risperdol dr. wants to add Remeron will it put me tranquilized? 
<chameo> I spent 3 years in a lock up psyche ward waiting for meds to stop me cutting, burning, attempting to hang myself and nothing changed until I decided to stop without drugs 
<lance37> I not hooked on it I do relapse every once in a while but I do it so I won't cut 
<DrM> Novartis is running substance p trials in Europe and US 
<Opalene> [1]Is there any correlation between hyperthyroidism and BPD? 
<DrM> No correlation between high thyroid and BPD. 
<_ellie_> I have been in therapy for five yrs, tried every anti-d, still cut myself and am not seeing any improvement. What am I doing wrong? 
<DrM> High thyroid will make it worse 
<weepippo> I have hyper thyroid also op 
<Opalene> Doesn't the stress of BPD affect the thyroid. Type A personality does. 
<lance37> I kind of feel if I raise the dopamine in my head I do alright 
<DrM> ellie, you may not be on enough of the correct one. If you have access to Zoloft, get on 200 mg/day and have a level checked 6-8 hours after your am dose. If it is not 180 ng/ml or higher, you will break down all meds fast and need higher doses 
<DrM> Dopamine increases are good for some. Wellbutrin, high dose Effexor, and Provigil do this 
<_ellie_> tried Zoloft....but will check that out. thanks 
<lance37> this is wrong 
<chameo> what lance? 
<lance37> dopamine chameo 
<bingle1> can you safely take more than 400mg Wellbutrin SR 
<DrM> dopamine increase concentration and energy 
<bingle1> wellbutrin sr 
<DrM> I would be careful about higher doses of Wellbutrin. Check with your doctor. Can cause seizures 
<lance37> so I can do that without heroin 
<chameo> so doc do you reckon no matter how much more work I do on myself the mood swings will never go 
<DrM> I hope. It is worth a try 
<DrM> Heroin is bad 
<lance37> I know 
<lance37> but I don't know how else to cope sometimes 
<DrM> Mood swings will never leave without correct med 
<chameo> f**k, so what’s the point then 
<DrM> the correct thing to do is get better. Illegal things are illegal for a reason 
<bingle1> when they leave will they stay away or will I need to take meds for rest of my life 
<bingle1> Moods I mean 
<Pattybpd> I think the Dr. is trying to say that if we can find the right meds., our BPD symptoms can be reduced. 
<DrM> meds forever. Like diabetes. May have a cure in 10-15 years with the DNA projects ongoing 
<weepippo> so we are biological freaks on terminal paths eased only by medication? 
<chameo> this is pants 
<Woodsey> chameo the problem with the nhs is it wont fund the new drugs 
<VicHam> any pts. of yours have alopecia w/hi dose Effexor? I did at 150 mg 
<DrM> no. I have diabetes and I do not think I am a freak. It is just the way it is biologically. I would be a jerk not to get better or as w2ell as I can 
<Freaked> SO WILL WE NEED TO BE ON MEDS FOR THE REST OF OUR LIVES? 
<chameo> I cant go thru these feelings again 
<DrM> yes freaked 
<DrM> Effexor and alopecia is new to me. 
<VicHam> could of been my vitiligo? 
<DrM> If you have used heroin and you are not better, doing the same thing again will not help any more than in the past 
<Freaked> can I ask an extremely important question? 
<TimLPN> I've have been on meds since I was 13 its just a state of being for me. I know I need medication or else 
<lance37> how high can I go on Effexor 
<_ellie_> yes freaked, ask 
<chameo> all the drugs make me fat 
<TimLPN> Or I can self medicate with alcohol to make me feel "normal" 
<Pattybpd> Freaked, I have to take thyroid meds the rest of my life due to hypothyroidism. Taking a pill in the morning does not bother me in the least. It is *ok* to take meds the rest of our lives. 
<_ellie_> me too chameo 
<Freaked> ok I want to adopt my step girls....will me being BPD on meds forever affect the court's decision? 
<bingle1> its ok but when you have more than 1 problem that you need meds for the rest of your life for is sort of depressing. 
<Freaked> will I lose custody because of this shitty disease? 
<DrM> lance, you can go up to any dose, but it usually works between 300 and 600 mg 
<VicHam> bald spots stopped after I stopped taking Effexor 
<VicHam> two yrs ago 
<DrM> sorry. Perhaps another med will work 
<Freaked> sorry it's not the same kind of questions people are asking :o( 
<weepippo> yes drugs are excepted in society for physical reasons not mental 
<DrM> mental is physical. It is just a physical reaction in your brain 
<Freaked> CAN SOMEONE ANSWER MY QUESTION? 
<TimLPN> Freak, questions like that are for the courts. Its up to a judge 
<_ellie_> I can answer what I think will happen, but that doesn't mean squat. :/ 
<TimLPN> Its better to show your getting treatment 
<Pattybpd> Dr., besides taking meds which is vital, are there some other tips for us to help us? Are there things we should avoid, etc. 
<DrM> If you eat carbohydrates, use complex ones 
<`bardamu> I think Freaked would like to know if DrM has had any experience with that type of situation. 
<DrM> Bread is better than simple sugar. Potatoes are better than chocolate 
<Freaked> If this DR has researched BPD he also would know the social ramifications of this disease...wouldn't he? 
<DrM> Freaked, I missed your question. Ask again. 
<weepippo> the treatment of BPDs as gomers is very alive and well 
<TimLPN> Freak, but not the legal ones 
<Freaked> I just wanted to know Dr if having BPD would stop me gaining custody of my step girls 
<Freaked> Tim I know it's legal but maybe he has known some similar cases 
<DrM> No. If you behave in a socially acceptable manner, it will not. 
<bingle1> Is anxiety a very common thing for bpd to have? 
<VicHam> what do you think of the new med reboxetine (coming out this fall)? 
<DrM> Having an illness is not a grounds for keeping kids away. 
<TimLPN> Freak, its all up to a judge, but in showing that your in treatment your showing you know you have a disorder and want to be better 
<DrM> Anything that can hurt the kids, is 
<_ellie_> Is psychodynamic therapy helpful for some bpds, doc? 
<DrM> psychodynamic therapy probably does not help much. 
<weepippo> what is the difference between Risperdol and Remeron? 
<DrM> They did a study in London about 10 years ago, and the suicide rate was 3x higher in the group with therapy vs. nothing 
<Pattybpd> I got much worse when I underwent "uncovery therapy." Got so depressed I had to take a leave from work. 
<entre2chaises> WOW. That's incredible that the suicide rate was 3x higher WITH therapy. 
<_ellie_> Is cognitive therapy helpful for bpds? 
<snowonthemountain> what is uncovery therapy Patty? 
<Freaked> I’m just depressed now that I’m screwed up with no hope of getting rid of BPD for good <DrM> cognitive therapy seems to be the best. 
<DrM> Freaked, you likely will be able to get rid of it with time. You have to make sure you start moving in the right direction now 
<bingle1> what is the difference between the 2 types of therapy? 
<VicHam> Dr, how about reboxetine, any promise for BPD? 
<DrM> cognitive makes sense. You say I do "A" and the therapist says lets figure a way to get rid of it or minimize it. 
<Freaked> well I’ve started therapy <Freaked> just no meds 
<`bardamu> DrM what are the long term ramifications of no treatment? Do the symptoms escalate, or, does it remain the same and only remain affected by outside stimulus? 
<Freaked> what is the best treatment for BPD 
<DrM> Psychodynamic is trying to get to hidden (subconscious) agendas. It doesn’t work 
<Pattybpd> Amen! 
<bingle1> thank you for the explanation Dr 
<weepippo> oic 
<DrM> BPD decrease with time. Even if you got no treatment, its intensity lessens after 45 or so 
<Gillian1> Can you become a recovered bpd, and control symptoms throughout your life 
<Gillian1> ? 
<snowonthemountain> Dr.Markovitz, is it realistic to believe that we can go through this recovery thing without the need for hospitalization? 
<DrM> Probably Gillian. Like any other disease, it lies along a spectrum. BPD's like any other disease come in different intensities 
<Gillian1> right, and I think I’m beating mine with DBT 
<Freaked> DR what is the best way to treat BPD? 
<DrM> You may never need hospitalization. If you do, so be it. It is not a failure, just what you need at that point in time 
<Freaked> what kind of therapy? 
<entre2chaises> I know that my diagnosis is "features of BPD" so I guess I'm on the "light" end of the spectrum. 
<DrM> Best way to treat BPD is to get a good doctor and therapist that can work together, and start working 
<weepippo> I’ve read there is associations between bpd and MPD your take? 
<DrM> I like Effexor XR, Serzone, and Zoloft, but others work too 
<VicHam> Dr M, I was dx'd w/BPD at age 45 . . . 
<entre2chaises> I *love* Effexor XR... it has changed my life! 
<bingle1> I love wellbutrin 
<DrM> which they are. They may be part of same disorder, and just a different presentation 
<bingle1> its a great diet aide also 
<entre2chaises> Wellbutrin and I didn't get along. I hear that happens with any drug. 
<DrM> I have had great luck recently with Provigil as an augmenting agent. 
<DrM> It really helps with attention, and is not addictive or habituating 
<entre2chaises> Freaked, I understand that DBT and cognitive therapy are best for BPD. Right? 
<Gillian1> What do you think of the combination of Klonipin, Neurontin and Remeron? 
<DrM> correct 
<Freaked> thanks 
<DrM> Gillian, if it works it is great. If it does not, get on something else. 
<snowonthemountain> yeah, I am 42- does that mean it will get better in a couple years?