Q. I have had BPD for about five years, and before that, bulimia. I cut and overdose regularly, and I recently drove my car into a wall-the car is a write off but I was fine!

I have been on aurorix, zoloft, prozac, tricyclics, luvox, cipramil, lithium, tegretol, carbamazepine, mellaril, haloperidol, clonazepam and another antipsychotic that made me put on 10kg in three weeks! I have also had about four courses of ECT. My current psychiatrist has pretty much given up on medications, as none of them seem to stop my Para suicidal behavior. I see a psychologist twice a week, but she is my third, and I have been through four psychiatrists. They dump me, I don't dump them.

It just seems never ending...is it worth trying other medications? And if so, which one?

A. We have gone over medications which help BPD in multiple prior letters. Not only do you need to be on the correct one, but also need to be on enough to work. I would suggest the following. First, take enough medication to reduce your appetite. This could be anywhere from 200 to 500 mg of Zoloft, 300 to 600 mg of Effexor XR or 500 to 1000 mg of Serzone. Second, avoid antipsychotics if you can. The controlled trials show that they are largely ineffective. The newer atypicals may be better, but there is almost no data to support their use. Weight gain is an issue, and Serzone with its 5HT2 antagonism should work just as well in most cases. Third, know what medications can and cannot do. They will get rid of the biological symptoms of the illness. These include cutting, mood swings, anxiety, suicidal thoughts, somatic complaints, sleep problems, and carbohydrate craving to name a few. They will not change your personality per se. You will be who you are now, but will have the ability to make changes in your life. That is where the therapy comes in. Lastly, there are always new medications being released that can help, so keep up hope.