Q. I have been diagnosed with BPD and Bipolar II. Over the past month I have been having annoying muscle spasms. They are real scary to me. Sometimes when I lay down on the bed the lower half of my body will twitch one way and the upper body will twitch the other way. I have a lot of twitching on the left side of my face. Otherwise the twitch can come from any part of my body. It seems that when I am working or socializing the symptoms go away. Sometimes, I have attacks where my body is shaking all over and I am unable to walk well because my balance is off. I am scared! I am scared that I am on a downward spiral with this and the rest of the borderline nightmare. I have a good job as a social worker. I worry that I will end up on disability for the rest of my life. I am also having physical problems with constipation, nausea and bladder infections. I don't know if they are related to my symptoms. I am on 300mg of Effexor per day, 50mg of Trazodone for sleep and 40mg of extended release Ritalin per day. These medication have made me feel better than I ever over the past year. I can't bear the thought of more medication changes -- the trial and ERRORS. Help please! I am terrified!

  A. What you have are myoclonic jerks (most likely) or tics (exacerbated from the Ritalin). You can do a few things for these. First is to see which drug is causing it. To do this you may ask your doctor about increasing the Effexor and stopping the Ritalin. If this is not an option, beta blockers can help a good deal. I usually use Inderal LA as either 60 or 80 mg twice daily. Third, you can use a strong benzodiazepine like Klonopin as 1 or 2 mg at bedtime. I do not like this because it is sedating, but it will stop the jerks if they are caused by the Effexor. If they are tics, and you cannot change your medications, a low dose neuroleptic could help. Talk all these over with your doctor for optimal care.