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

Page Four

<snowonthemountain> but doctor I am afraid if I go back in they will keep me for months- it was supposed to have been 3-4 months the first time 
<drewbug> don't even know if there is any hospital around here other than state... 
<entre2chaises> Some of the people at that hospital were from out of state. 
<DrM> The world is not perfect, anast. One bad experience does not make the whole system bad. 
<anast> OK DRM, as a diabetic, if I overeat, on a constant basis is that considered SI? 
<TimLPN> and with insurance the way it is they keep people as less they can 
<anast> DRM, no one knows that more than I 
<entre2chaises> anast, it is in my book 
<Gillian1> SI? 
<anast> BOOK, what book? 
<entre2chaises> SI = self injury 
<entre2chaises> anast, it's an expression 
<DrM> Depends, anast. If you are on Zyprexa or Remeron, you will have no biological choice. If you deliberately/volitionally do it, it is not healthy behavior at a minimum. 
<_ellie_> I think over-eating in a different problem from self-harm 
<Freaked> I’m a big over eater <anast> I have been purposefully eating excess sugar 
<entre2chaises> When I was overeating, I knew I was harming myself. I knew it would kill me eventually. 
<drewbug> anast... sounds like you answered your own question 
<DrM> Sugar is a way to get tryptophan into the brain to make serotonin. Maybe you need more, different or better meds. 
<anast> I know! 
<entre2chaises> I think the excess sugar crave is a kind of self-medication, only it makes it all worse. At least, that is how it is for me. 
<twisted6> hmmm.. will it ever go away?????????? 
<Pattybpd> Dr. is it true that BPDs normally have large carbohydrate cravings? If so, why? 
<_ellie_> Patty, I sure do! 
<DrM> Lady named Wurtman at MIT did a ton of work on sugar eating and how it effects body. May want to look up her books 
<bingle1> will meds to increase dopamine also increase serotonin? 
<DrM> depends on the med bingle 
<anast> I am taking 300,mg Effexor, 150 wellbutrin and just got put on Neurontin 600mg 
<Opalene> I wish there was a way that we could all get our hormones scrutinized I am sure we will all have something unusual in common 
<DrM> anast, have you been on 450 or more of Effexor? 
<entre2chaises> I found tremendous relief from many BPD symptoms when I became a strict vegetarian. 
<_ellie_> that's interesting entre 
<drewbug> fyi... there's a new book out called the anti-depressant survival book (or really close) that looks fairly useful... or might be if I had more willpower ;) 
<DrM> there is some data to suggest reducing carbohydrates may help some with bpd 
<anast> no doc, my doc wouldn’t do it, he put me on the Neurontin instead <bingle1> what meds would increase serotonin? 
<entre2chaises> I typically avoid sugar & caffeine very successfully, but the other day I had a little binge of sugar and caffeine. 
<bingle1> I already take wellbutrin but I also really crave sugar much more than I ever have 
<DrM> anast, have him read my BPD paper in Psychopharmacology Bulletin. 450 of Effexor alone will do it for you 
<entre2chaises> I then went on an online shopping binge... ugh. 
<Pattybpd> I know that imipramine causes sugar cravings in some. 
<drewbug> entre... know that feeling :/ 
<Skreee> back 
<anast> he told me that you don’t treat bpd, you treat the sx <DrM> entre, you may have eaten sugar because an episode was coming on. Like having nausea before you vomit, and the binge shopping was the continuation of the cycle. Not cause of the sugar 
<entre2chaises> FWIW, there's a big difference between refined carbs and those in whole foods. 
<anast> so I am taking all these drugs for nothing? 
<entre2chaises> I do not recommend high-protein diets at all. 
<DrM> if the drugs help, its great. If not, try something else 
<Gillian1> Dr, I want to get back to work doing nursing as soon as possible, 
<Gillian1> but the medications make me sleepy and forgetful 
<DrM> There was no effective treatment for BPD of note prior to Prozac 
<Gillian1> Are they some that would not 
<entre2chaises> Thanks, DrM. I thought there may have been a connection. 
<Gillian1> *some 
<drewbug> how do I know if they're helping> what if I could feel better and I just don't know it? 
<anast> Gillian that is a constant state for me lol 
<crazyme66> Dr. how can we get our mind to stop thinking either we are good or bad, like one day I am really in a good mood then the next day I can be suicidal...just depends on my thought for the moment or day. I flip back and forth all the times sometimes with in the same day 
<DrM> Gillian, the Provigil (modafinil) may help you a ton 
<drewbug> I would give anything to have my mind just *shut* *up* 
<entre2chaises> Gillian- ditto anast 
<DrM> 66, that is where the therapy helps. 
<ForestLobo> drewbug-know exactly what you mean 
<_ellie_> DrM, what do you think of Celexa for treating depression and bpd? I am on 20mg. 
<ibtawny> didn't have time; no abuse from here though. 
<drewbug> ellie... I’m on Celexa too... thanks for the question :) <DrM> ellie, it s okay, but most folks need 60-120 mg/day to work 
<_ellie_> really? oh. 
<entre2chaises> Celexa didn't work for me. 
<crazyme66> I have been in therapy for 3 years and not sure if it helps but afraid to leave her cause I like talking to her and she has helped thru some rough times 
<DrM> all the SSRI's (Prozac, Zoloft, Luvox, Paxil, and Celexa ) are pretty much the same 
<drewbug> wow... 4 out of 5 on that list, just within the last 3 years 
<snowonthemountain> kids needed me! 
<ForestLobo> Therapy, writing, meds, sleep if all else fails 
<anast> Doc did you answer my ? about where I can find you paper? 
<entre2chaises> gillian, my vegan diet has helped me a LOT with my energy level. 
<crazyme66> thanks ellie you always understand me, so I don't feel so alone 
<drewbug> forest... yeah... I sleep a lot :/ 
<_ellie_> aw. you're welcome! (((crazyme))) 
<Freaked> I’m going to need to go on meds.... I have no idea what I need <DrM> Any medical library will have a copy in Psychopharm Bulletin. <ForestLobo> It is that or permanent oblivion drew 
<Gillian1> I eat no red meat just chicken and fish 
<TimLPN> Anast, you'd find the paper at a medical library 
<drewbug> freaked... it's okay... that's what the doctors are for 
<Freaked> what happens if I get a screwy pdoc 
<Opalene> Dr. M do you know any research that I can follow concerning BPD's ramifications on the body? 
<twisted6> DrM.. medicine doesn’t seem to make the difference from what I can see, why do doctors keep prescribing <drewbug> freaked... then you go to someone else 
<_ellie_> Freaked, just tell the doc all your current symptoms/problems 
<DrM> No data I know about concerning BPD's ramifications on the body 
<Freaked> lol that would take forever 
<ibtawny> I've found medication very helpful 
<ibtawny> but I guess you have to find what works for you... 
<_ellie_> ;) freaked, write them all down. 
<entre2chaises> twisted, meds have made all the difference for me... once we found the right one. 
<TimLPN> I think medication for most mental illness is trial and error 
<Gillian1> Dr. Markovitz, do you see bpd more in any ethnic group more than others? 
<snowonthemountain> my t told me that I was working too hard to overcome the bpd- Dr. M. do you think that is possible? 
<DrM> It is not easy getting the meds balanced. 
<DrM> No, you cannot work too hard to overcome BPD. 
<drewbug> Dr. M. ... how do you know when to just give in and decide "okay, this is as good as I’m going to feel on meds"... or are you supposed to just keep trying? <snowonthemountain> Can you become too focused on the bpd recovery - is that what he might have meant? 
<DrM> One of the reasons they call people bipolars or depressives when hospitalized is the hospital is not paid if they call you BPD! 
<_ellie_> woah. that is so wrong 
<entre2chaises> drew, good question 
<ibtawny> my therapist said that bpd is over diagnosed; should I question my diagnosis? 
<DrM> You have to focus realistically on recovery. Not obsessively 
-Pattybpd- Ops, don't you all think it would help if everyone shut up to one another and just focused on the doc? That's what they did when I attended a chat with Dr. Markovitz. 
<DrM> ib, if you have the symptoms, it probably is BPD. 
<entre2chaises> This is really interesting, but I have to go. Thanks for being so kind to me during my visit.