Q. I am ADD (Attention Deficit Disorder) and although Ritalin helped me to concentrate enough to hold an office job for a while (I am very highly educated) I eventually got fired for mood swings. I added Tegretol and it made me depressed all the time. I added Prozac (20 mg day) but it made me foggy, I didn't want to eat anything except carbohydrates, I hated the feeling that I can't cry even if I want to, and the feeling that I was fine even when things were going wrong and I should probably have been concerned. I felt that it made some of the ADD symptoms better but some of them worse. I cut out the Tegretol to see if I am bipolar as well and went into rapid cycling so extreme that I was lucky to live until the mood stabilizers kicked in again. I am now on Topomax which helps stabilize the moods a little so far and control over-eating, and still on stimulants which I feel I need if I am going to do any work at all.

The problem is that there is still something very wrong. I fit all the borderline criterion. The weird thing is that as long as I am on Ritalin I am more or less okay most of the day but as soon as it wears off I can plunge into depression within the hour. And I go straight into borderline thinking like switching from Jekyl to Hide. For example, I can be okay with someone as long as I am on Ritalin but as soon as it wears off I will be obsessing about how they have treated me badly or whatever....

What is the relation between stimulants and BPD? And please don't just tell me to ask my doctor. I am isolated overseas and the psychiatrist I e-mail doesn't know at this stage what to do.

A. My suspicion is that the stimulants are treating part of your symptoms, and they wear off and you feel worse. You need to find a medication to cover everything. SSRI and SNRI antidepressants are pretty good, and you can use the Ritalin along with it until they kick in. I will tell you, however, to go over it with your doctor and not do anything on your own. I know very little about you, and am only making a suggestion based on the little bit of data you supplied.