Q. As a diabetic myself. I'm trying to find out if the craving for carbohydrates is the same. As I crave sweets the higher my level goes up. In bpd does this craving do the same as someone who has ADD? Which would keep them up late hours at night? My partner has BPD and I've noticed when she has sugar at night she has a hard time going to bed. She does take Trazodone at night but I think she needs to elevate the dosage. She only take 50mgs. I'd appreciate if you could answer me or give me directions on how to find an answer.

A. This is a great question, and is a good clinical sign of type of illness. Carbohydrate craving seems to be a symptom of many of the illnesses we treat as clinicians. I have mentioned in many other answers that a sign of efficacy for any of the antidepressants is reduction in carbohydrate craving. I stand by this. Carbohydrates will increase tryptophan in the brain, and this increases serotonin, which makes the patient feel better. It is an insulin dependent pathway. Basically, eating carbohydrates is a way of self-medicating, albeit an overall ineffective one.

In your partners case, and I am going to assume a lot here, he or she probably had a preexistent sleep problem. It has just not been addressed yet. Otherwise, there would be no carbohydrate craving nor need for trazodone. Trazodone is great stuff for knocking someone out, but it does not fix the underlying problem any more than Valium, Ativan, Ambien or any of the other medications used for sleep. They just relieve a symptom of the disease. Your partner does not sleep because of the disease, not the carbohydrate craving.

Diabetics, interestingly, have higher rates of depression, probably because eating carbohydrates for them does not work to decrease their illness. They have no insulin to release, so do not pump tryptophan into their brains to make serotonin as well. This results in less efficacy in self-medicating by eating carbohydrates.