Q. I was diagnosed being Bi polar II, Borderline Personality Disorder (I call a disease), possibly DID, severe Major Depression, recurrent, and Post Traumatic Stress Disorder. Right now I am in an excruciating major depression along with all the things that are going wrong with my BPD & DID that is so bad I was hospitalized for 12 days (2 in ICU) for overdosing on pysch meds and severely cutting my arms so lost a bit of blood as well. I have no memory of any of it but what the police report said; I am not trying to not take responsibility for what I did to my-self and I see the cutting marks on both my forearms so I know I did it but I don't remember the trauma that started it nor what brought it on except that I felt abandoned very intensely.

I was let out of the hospital after 12days (10 days in locked security ward) because of still being suicidal and still intensely wanting to cut myself. Right now I am on Effexor XR 225 mg, Prozac 60 mg, Trazodone 150 mg. and Temazepam ( I don't sleep at all without the last two) but for past 12 weeks I have not slept more than 2-3 hours per night and those hours were very restless. My depression is NOT lifting at all, I have a therapist who is not very supportive and I feel has abandoned me in these times where life HURTS too much to stay in it. The only BPD patient he has tried to treat is ME for past 4 1/2 years. I feel we have come to the end---gone as far as we can go with my treatment---but feel very guilty in wanting to tell him I want to stop seeing him because I am just not getting anything back from him in helping me get through these times.

My Psychiatrist has put me back into the hospital in the "day program" where I must show up every day and participate at listening to four women who run the program tell how to go about changing our lives and making our lives better. Right now I cannot focus, concentrate or able to see this as helpful because I just cannot get with the program no matter how hard I try. I have no interest in anything that has to do with life period so I have no interest in all the things I use to like to do. I cannot openly cry in front of people so I don't cry there I will tear up but I only cry at night when by myself (as I am doing right now trying to type this out)...because I am so immensely miserable. I am too lethargic to even pick up a razor to try and cut myself out of frustration & feeling a numbness about me that HURTS! I am really in a mind/brain melt- down, shutdown. They keep pushing me to move and think and make choices I cannot even SEE any of, so I go away feeling worse & intolerable; I am sure they feel I am intolerable too because I just cannot seem to respond to any of their lectures.

I have ALL the signs & symptoms of BPD, I didn't know what disassociation was but I know I do it now that I have read about it when I am cutting. When I was being physically abused and psychologically abused by my father & teachers from kindergarten to third grade I got to where I could take myself away from the excruciating pain and put my mind, myself, somewhere else while it was happening. I do that now with the cutting so I do it out of deep stress & frustration with emotions I was NEVER allowed to let loose or express; my life was one traumatic experience after another from infancy. I was diagnosed as Bi polar (manic depressive) at the age of 14 years and behavioral problem (all the symptoms of BPD but no one knew what that was in the 60's (my parents & family didn't believe in mental illness, wouldn't address it nor admit they had a daughter that had mental illness problems). But I can see now that I was also BPD in there too all those years because of reading the symptoms of it.

My state of mind is hangin' on a very short weakening thread and I don't know how to dig my- self out and I am really losing hope in myself & how I will be able to change things. My meds are not working, the severity of this depression is not lifting, I don't know why, I am suicidal most of the time and the intensity to cut myself is so intense (they are trying to help me stop) that distraction is no longer working for me. I spend all my time distracting myself on this computer in this Borderline Sanctuary site hoping things will lift and I will find some HOPE but life is so meaningless right now I don't feel nor see any hope in this dark prison; the pressure of trying to "get better" faster and "making progress" is to me unbearable. I have no memory of stuff..took me three days to find my glasses because I could not remember where I put them; my son found them because I could not see them. I lose things, can't remember things told to me, I feel so hopeless, so worthless, so resistant to not only the support but to the meds my Dr. has given me. He is taking me off the Effexor XR to put me on Serzone. I am still so dragged out all day that I just want to hide under the bed so no one will find me and sleep but I don't sleep anyway.

Dr. Markovitz, I really am losing ground here fast. I try to explain this to my therapist and these women but it goes unheard and I feel guilty because I am not responding to all their constant lectures. My Psychiatrist is trying his best to help trying to address the depression and the lack of sleep right now; but then I am irritable, angry, restless, edgy, feel abandoned by life and cutting on myself (only to hide it so no one will know..) which then I am feeling guilty a bout for lying about it because of all the huge stress and frustration. I am so confused, disassociated and SO deeply depressed I don't believe that it will EVER go away.

What do I want to ask you?? I want to ask you a lot of things but don't know where to start :-( I have tried to hook up to the "Suicide Support" site in here but they tell me that it doesn't exist. I know it is all up to me Dr. Markovitz yet right now in this excruciating deep depression that won't lift I am not doing what I should be doing to help myself. I know I need a new therapist but I feel guilty telling the one I have that I am not getting out of our sessions what I was anymore. It is not easy either because I am also on Medicaid being on Disability because of my mental ill health therefore, it is not easy to change and what if I do and that person does not work, I can't work with that person, or I end up worse off than I was.

I am sorry this is long but I need to know about severe major depression along with BPD out of "sink" ---- I am a mess and I am tired and sick of being so sick and so tired, so "dead" any way. Are there any other BPD's who get to this place & cannot get out to get better?? How do I find a therapist who also treats BPD people and what is the treatment anyway??

A. I am sorry to hear about your case. Mostly because it is painful to hear about any human being suffer. It sounds as if everyone is doing the best they can to help you, but everyone is a bit stuck at this time. I would recommend doing the following.

1. Talk to your doctor before you do anything below. Copy this and take it in if you need to do so, but do not make changes on your own. Show him this and see if it helps get things going.

2. Try increasing the Effexor XR to 450 mg/day. It is what most folks need and there is a ton of data in the literature to support this. The Canadian group went to 600 mg/day in their study. Check your blood pressure as a precaution, but it should be okay. Effexor occasionally makes it go up.

3. If you are not improving or getting better in one week after starting Effexor at 450 (or 600 if need be and you are a smoker), add Zoloft as 200 mg in the AM and check a level of sertraline (Zoloft) 6-8 hours after the AM dosage on day 5 or onward. If it is not at 180 ng/ml (+ 5%) increase the dose to get to 180 ng/ml. Since Zoloft is linear, if the level comes back at say 90 ng/ml, you will need to take 400 mg.

4. As a quick fix, you may want to try adding Provigil as 200 mg in the AM. This is a controlled substance with almost no abuse potential, and often helps folks to improve.

Good luck. Write back with any questions or have your doctor visit the site.