Q. My 17 yr old daughter has been on every meds "cocktail" combination for the last 4 years: Prozac, Effexor, et al. A week ago, her meds doctor started her on Remeron at bedtime, took her off Prozac (80mg day), left her on Tegretol (200 mg day) and started her on Seroquel 3 times a day. (She hears voices). She has been diagnosed BPD by many doctors over the last 4 years. He has had her on Ambien (15 mg a night) for insomnia for over 2-3 months now. Yesterday she announced she had been taking her Ambien during the day while at school (10 mg. a.m., 10 mg p.m.) on her own, and that it was the first med she has taken in all these years that allowed her to feel "normal" and happy throughout the day. I looked Ambien up on the internet and it says it is highly physically and psychologically addictive. Needless to say, it no longer makes her sleepy. I saw your response on the BPD "Ask the Doctor" board re: someone who was self medicating with hydrocodone. Why would a sedative/hypnotic like Ambien have this kind of uplifting effect? I am going to call her meds doctor and inform him of what is going on, and I'm sure he will discontinue the Ambien. What else would possibly have this same kind of effect on her? I don't want to sanction her taking "drugs" (Ambien), but her degree of BPD is extremely severe, and she feels without the Ambien, she has no hope.

A. This is the fourth case like this I have heard about or treated in the past 8 years. I do not know what it is, but some folks really do better on the Ambien during the day. I cannot tell you why, nor will I recommend doing it in patients. In a few rare cases, however, it seems to help.