Q. . I have been a mental health patient for 15 years diagnosed with BPD. I have been prescribed almost every class of psychotropic drug with either dismal results (extreme side effects), or some relief. Because medication often does not effect (long practiced) behavioral changes...I find that I am in the position of wanting to just give up. I have been aggressive in my quest for healing therapy: even trying Primal Scream for a while...which just about did me in. The therapist had me believe that I was her daughter from a former life, etc. To say the least, I have come across more than my share of nuts.

Bottom line is that I am tired, broke, disheartened, disillusioned, and bitter. When is it OK (professionally speaking) to just throw in the towel and end the suffering (please read the inference)? I am currently taking Effexor XR @ 300 mg daily, and Zyprexa @ 5 mg daily.

  A. Since it is a biological illness that waxes and wanes, I truly believe it is never okay to throw in the towel. Honest. Heck, you even note that sometimes meds help. Ask your doctor to increase your Effexor XR to 450 and see if this helps. It is the average dosage in BPD. About 20% of the folks I treat need 600 mg/day. If this fails, write back and we can go over other options. If you are gaining weight on the Zyprexa, it may be worthwhile to ask your psychiatrist about Geodon. The Geodon seems to work better in BPD that I see, and does not have near as much sedation or weight gain.