Q. I have suffered from Borderline Personality Disorder for the past two months. I have always suffered from bipolar depression, but after an allergic reaction to Compazine in the ER I started having anxiety so overwhelming I convulse and shake and have thoughts of suicide. I am always depressed, never calm, always anxious, and have uncontrollable angry mood swings toward my husband. I am in therapy. I take 500mg of Serzone at bedtime, 30 mg BuSpar 3times daily 4 mg Gabitril four times daily, 1mg Ativan four times daily. I have been on these meds for two months and NOTHING seems to help. I even try exercising, deep relaxation and reading. Please help. Can recommend any meds?

A. There have been a number of letters discussing treatment, and I owe Tim and Patty a monograph-type letter on treating BPD. Always talk with your own doctor before trying anything, since I know little of your case. In your case, you might want to try increasing the Serzone to a higher dosage, perhaps 600 or 750 at bedtime. If you smoke, you will need a higher dosage of Serzone (or any other medication for BPD). If you have obsessive compulsive symptoms, Serzone probably will not help much, and you will need either a SRI (Prozac, Zoloft, etc.) or a SNRI (Effexor XR). In our Prozac study, everyone used 80 mg per day. Zoloft averaged about 300-400 mg/day, and Effexor about 300 to 400 mg per day. We never tried augmenting BPD with BuSpar very much, but it is a good theoretical intervention.