Q. I suffer from dysthymia & anxiety (incl. social phobia), which might also translate into BPD when looking at the diagnosis. I often have bad dreams, and wake up fairly paralyzed in the morning with disturbing recurring thought patterns. Also, I often have paranoid thoughts, et al about being an other in the world (even though I am aware that it is not reality). Recently I have been getting panic attacks.

Apart from psychotherapy, what medication would you recommend? What am I dealing with here?

A. For what you describe, there are currently four viable options.
1. Effexor
2. Prozac, Zoloft, Celexa, Luvox, or Paxil
3. Serzone
4. Remeron

Each of these represents a unique drug class that will theoretically cover your symptoms. They might all work, or none might work. The depersonalization you are describing, is likely part of the panic symptoms. You do not need a full blown attack to feel depersonalization. If you are put on one of the above medications, you should get on the one that "fits best." My preferences, purely because of familiarity, are Effexor XR, Serzone, or Zoloft. These tend to have the fewest side effects overall. None are perfect, and what is bad for a friend may be great for you.

Therapy is of limited value without appropriate pharmacotherapy.