Q. I have some questions concerning my 15 year old daughter. She has been treated for several years for what her doctor calls a mood disorder. Some of her symptoms include severe depression, suicidal thoughts, rages, extreme mood swings, cutting, dysphoria, and carbo cravings. She has been on 225 mg of Effexor XR for the past year and is doing much better. Her doctor recently decreased her dose of Effexor to 150 mg to see if it would help with her complaints of being constantly tired, poor nighttime sleep, headaches and stomachaches. These problems did not diminish, but she quickly became more agitated and started to cut again, so the dose was adjusted back to 225 mg. Her doctor seems very reluctant to go any higher on the Effexor, but from readings on this site, is it correct that some of these somatic problems may actually improve at a higher dose of the Effexor? She is a very bright, talented youngster, but has a hard time making it through a full day of school at this time. She also takes 1200 mg of Carbatrol for complex partial seizures, which have been under control for 2 years. I have asked her doctor if she may have BPD, but he says since she hasn't been abused, she can't have it. My sister, who was sexually abused as a child, has been dx with BPD, and I can see many similarities in their behavior. I have seen what untreated BPD can lead to, and would like my daughter to have a better chance at a happy life than my sister has had.

A. Good questions. First, you do not have to be sexually abused to have BPD. Second, there is a lot of data that higher dosages of Effexor work better. My own work aside from Psychopharmacology Bulletin, a number of other groups have shown higher dosages work. My guess is that your daughter will need 300 mg at a minimum and perhaps as much as 450 or 600. The medication is much more benign than the illness, so there is not much to lose. Talk to your doctor, and see what he can do. Adolescents actually chew up medications more quickly than adults, and she may need more for this reason. The stomach aches, headaches, carbohydrate craving and lethargy will all diminish greatly or resolve on higher dosages.