Q. I am a 34 y/o female. 12 yr hx as RN and 96 credits toward physician assistant degree. I am now disabled d/t mental illness. dx with bipolar but now possible bpd. Developed partial complex seizures in 1996. MRI shows pachygyria in r. frontal lobe, hypoplastic fornix, and septum pellucidum not fully formed. Also suffer migraines which neurologist feels may be r/t seizure disorder. The behavior problems have been lifelong. Have read extensively on bpd and agree with dx, but have asked my neurologist, psychiatrist, and therapist if this is related to the abnormal mri findings. No one knows and no one seems particularly interested in pursuing it. I strongly feel that this, at least in my case, has an organic basis. My former psychiatrist, who ordered the MRI agreed, but she left the area before we could look into it further. I take Depakote 1,000mg BID and Prozac 20mg qd. I have been up to as much as 40mg of prozac but feel that it makes me irritable and aggressive. I have taken Risperdal 1mg or 2mg in the past with fairly good results but it makes me tired. I really would like to know if the disorder is related to the MRI findings as I suspect. Could you possibly review the MRI report and give your opinion? Any help you give would be greatly appreciated. Also, the prozac does work for the depression, but I do not like that it makes me feel aggressive. Have tried Paxil and Zoloft with same results. Definitely need antidepressant. Tapered off last summer with disastrous results.
A. I would be unable to review the MRI, and even if I could, any findings would not change my treatment plan. I know that certain behaviors can be treated with antidepressants, and others cannot. If your behaviors arise from a malformation or death of brain tissue, there is not much to be done. If it predated this, then I would treat it the same way I treat all folks with BPD. Heck, even if the MRI findings were consistent with BPD-like behaviors, I would still use anti-BPD medications to try and resolve it. You have nothing to lose.
If you are not obsessive, you might want to consider using Serzone (nefazodone) as 500 mg or so at bedtime. It is pretty good in non-obsessive BPD, has less seizure potential, and a different side effect protocol than SRIs. Good luck.