Q. I've got a very close friend who has been diagnosed with Borderline Personality Disorder since two and a half years ago. She is a 22 year single female, coming from a dysfunctional family. She is taking Paxil 20 mg, Risperdal 3 mg and Nozinan 12½mg. Still I really find she is very depressed and highly suicidal.

A little more than a year ago she began gaining weight. She has gained more than 50 lbs. in less than a year. Besides, since October 1999 her menstruation has not stopped! So she is now on a Provera treatment. But this treatment is not helping. On the contrary; it has worsened the bleeding. Moreover, recent blood tests have shown that she has high sugar levels. Our family physician explained to us that it is all caused by the Risperdal, since it deregulated the balance in the hormones. Insulin is also a hormone, so that's why her sugar is high.

My questions are:

1) Is it true that the Risperdal is responsible for the hormonal and thus menstruation dysregulation? Is it also responsible (maybe indirectly) for the high sugar levels in the blood? And if so, is there an effective alternative for Risperdal?

2) Is only the Risperdal to be blamed for the weight gain, or has the combination of psychotropics done this?

3) Can a higher dose of the antidepressant or a change in it help her be less depressed and/or suicidal?

A. There are so many possibilities, it is hard to say what is doing what in your friend.

1. Risperdal is usually associated with a lack of a period, not a cause of one. Your brain may think you are nursing because of the effects on a chemical called prolactin, and you can actually lactate. This is not all that common, and the finding of causing one to menstruate would be uncommon, and I have not heard of it.

2. The weight gain is probably caused by the medicines and inadequate treatment of the illness. People eat sugar to push more tryptophan in their brain to make serotonin. She probably needs more Paxil. I doubt the Risperdal caused all the weight gain by itself.

3. I have not seen Paxil work below 60 mg/day in BPD and usually 90 mg/day.