Q. I too have been diagnosed with BPD for almost 10 yrs. I have tried numerous meds and went for years of therapy. In addition to BPD, I also have depression, feelings of self-worth, guilt, have become dependent upon pain meds or anything that would make me feel alive inside. My anger and rage episodes have destroyed many relationships and my current husband is ready to call an end to this roller-coaster ride he claims this marriage is. My 3 children are suffering deeply because they don't know how I will react to anything so they live on pins and needles trying not to set me off. I hate being this way and would love to find the right meds to help. The latest med I was on is Zoloft 150 mgs daily. At times it helps my outburst but leaves me feeling depressed that I cant be near people or I become paranoid that people are talking about me. After reading the many letters from other people like myself, it seems to me that Zoloft or Effexor are the two top meds that help with BPD. However, in my case I don't think I am on a high enough dosage that you have commented to others. My physician is now tapering me off Zoloft and has placed my on Serzone 200 mgs twice daily. Needless, to say I am extremely agitated and blow everything out of proportion. Its almost as if I am intentionally trying to sabotage everything or everyone around me. When my episodes of anger/rage diminish. I am then totally exhausted and want to sleep., I try to stop the cycle but my brain is self explosive. I have also tried Lithium, Depakote, Klonopin, Neurontin, Mellaril, Tegretol, - you name it and they tried it.

I desperately need your expertise and advise me if I should recommend to my dr. to increase my Zoloft instead of Serzone or should we attempt a high dosage of Effexor - I tried it once but didn't allow myself to get to the correct dosage because in between meds I BECOME SELF-DESTRUCTIVE. Also, should I go on a mood stabilizer with an antidepressant to help with my mood swings. I also have an eating disorder and some of these meds make me put on extra weight. This too could put me in a rage episode because the weight gain makes me see myself as a failure. I know you are extremely busy but I can only hope and pray that you could take a few minutes of time to try and help me with what you think could control my bouts of anger and self worth. I am genuinely a good person and I love my children and my husband but I also know that they cannot go on much longer with living with someone who has BPD. .

  A. I do not know enough about you to say what is right or wrong for you. If you use Zoloft, the beauty is you can measure how much is in you to see if it is enough or not. To do this, you get a serum sertraline level between 6 and 8 hours of taking the Zoloft. The level should be greater than or equal to 180 ng/ml. Zoloft has linear kinetics. Basically, if you come out at 150 ng on the 150 mg/day, you will need to be on 200 to get the level up (it will be about 200 ng). If the level comes back at 90 ng/ml on 150 mg, you will need to be on 300 mg. If it comes back at 70 ng/ml, you will need to be on 400 mg/day. You must be on a set dosage of Zoloft for 5 consecutive days before measuring a level for accuracy.

If you do use a mood stabilizer and weight gain is an issue, Topamax causes weight loss or no weight gain, and would be a good choice in someone with an eating disorder.