Q. About a year ago I was diagnosed with Depression, dysthymia and Borderline Personality disorder. As a child I was also diagnosed with Attention deficit hyperactive disorder. After I was hospitalized for trying to commit suicide, self mutilation, some paranoia and inability to interact with others. My doctor prescribed me Zyprexa (changed to Risperdal then back to Zyprexa), Clonazepam, Epival and Paxil (which was later changed to Wellbutrin then changed to Zoloft). None of these drugs seemed to really help except with the suicidal tendencies. Some of the bad side effects were weight gain (about 40 lbs.), tiredness, sexual dysfunction and a feeling of being in a "zombie like" state. I have quit taking my medication and seeing my psychiatrist for about 2 months and seem to feel better. I know it was probably not a good idea to quit taking my medication and have been thinking of maybe seeing another psychiatrist that may be able to help me better.

A. Unfortunately, if you have been self-injurious and suicidal in the past, it will probably come back. Two alternative approaches might be worth considering. Serzone at 500 to 600 mg taken at bedtime can be very effective in BPD if it is not accompanied by obsessive compulsive disorder. Effexor has some sexual dysfunction, but less than the SRIs (Prozac, Zoloft, Paxil, Celexa, and Luvox). Interestingly, the higher the dose of Effexor, the less chance there is of sexual dysfunction. So, if you get it at 150 mg of Effexor, you probably won't at 300 or 450 mg. of Effexor. Always use the extended release Effexor to minimize side effects.

If these fail, you will need to do a cost benefits analysis to decide if the pluses of taking a medication, even if the benefits are not complete, outweigh the disadvantages. This should be done with the doctor overseeing you. If you are uncomfortable with your pharmacotherapy, see someone else. No credible doctor will fear a second opinion for another credible doctor. BPD is permanent, like diabetes, and needs to be treated chronically. Pick the medication that fits you best and works best. Work with your doctor and therapist. Always tell them your concerns so they can address them. If they do not, go elsewhere for another opinion. Never stop your meds or change them without medical supervision.