Q. Since 1987, I've been diagnosed with a variety of mental disorders, one of which is BPD. I've been seeing the same psychiatrist for 12 years for medications. I've been in supportive type therapy for 3 years with one therapist and then 7 years with my current therapist. I'm a 44 yr old female. I've been married for 22 years. I have two children in college. I have all the basic necessities required to survive: shelter, food, clothing, love, etc. which have been provided by my husband because I've been unable to keep a steady job. My question is about the anhedonia that I experience almost constantly. I believe that my persistent obsessive thoughts regarding death may be connected to the anhedonia. Is anhedonia treatable with medication and if so which meds would target the correct neurotransmitters in the brain?

A. These are all very good questions, and I may not have the exact answer for which you are looking. On the positive side, all of the anhedonia, suicidality, and obsessionality are treatable with medications. Trouble is, I do not know which or how much is appropriate for you. Many physicians do not use enough medication to treat the maladies you have. One choice is to use Zoloft and measure a serum level to see if there is enough in you to work. For BPD you need a serum level of 180 mg/ml six to eight hours after your morning dosage of medication. This almost always corresponds to a reduction in carbohydrate craving (if you have this symptom). Most of the newer medications will work for the majority of patients. Unfortunately, I cannot tell you which is the correct one for you.

Your illness has a biological basis, and will respond to the correct biochemical treatment.