Q. I've been on many different meds for BPD. So far Effexor XR and Stealzine are the best for me. They seem to calm the rage inside. However, the depression never seems to go away completely. I was taking 225mg of Effexor XR. I showed my psychiatrist your info about taking larger doses until the carbo hunger disappeared. He went along with your recommendation. We raised the dosage by 75 mg each time I visited him monthly) The carbo hunger does disappear, initially, for a few weeks and, unfortunately, then comes back with a vengeance. I am now on 600 mg Effexor XR (and 5mg Stealazine) daily. I don't think that my doctor will continually raise the dosage. If the carbo hunger doesn't disappear does that mean the med is not working?

A. Good question. First, the loss of carbohydrate craving is temporary, and usually lasts 6-8 months, and then it returns. The carbohydrate craving, not the BPD returns. Stelazine, as well as other neuroleptics, cause weight gain, and this could be part of the problem, too. I have gone higher on the Effexor XR, but not very often. You might want to consider using Moban, which is supposed to have a lesser chance of increasing weight. Pfizer has a new atypical antipsychotic coming out soon, and it is not supposed to cause weight gain. Still another possibility is to add Serzone, a 5-HT2 antagonist on, and work up to 500 mg at bedtime to see if it helps with anxiety. 600 mg is a pretty good effort on both your parts, and further increases possibly could help, but the yield will be low.