Q. I have been on many different classifications of anti-depressant and anti-convulsive medications to treat PTSD - trials from 2 weeks and up to 9 months. I seem to be very sensitive to any medications, so doctors have tried low dosages, with the result that there is no therapeutic effect but still the bad side effects. Reading your page and that of Dr. Heller, I wonder now if I may have BPD - the symptoms described seem to fit my behavior (cyclically) and also several other family members. Medication seems to be called for, but I have had little success in the past, and trials have been upsetting and disruptive to my work and family life

Even low dosages of SSRIs seem cause severe agitation over time - within about a month of taking the medication. Memory difficulties also are a problem, especially with Paxil, which I see you do not recommend generally. Wellbutrin and Buspar were ineffective, as were tricyclics (from which I had terrible weight gain). Depakote produced very upsetting side-effects. Even very small doses of benzodiazepines cause severe depression and suicidal thinking. If you have noticed this pattern and have a recommendation, I would greatly appreciate hearing it.

A. Your medication regimen described is almost a litany of what not to do in borderline personality disorder. Benzodiazepines are a no-no. The one double blind study done by Gardner and Cowdry showed them to be very bad as they increase suicidality and self-injury. Depakote is depressogenic in just about everyone with BPD. It will also make you fat, give you tremors, and frequently cause ones hair to fall out. Paxil is without question the most ineffective medication I have tried in BPD of all the antidepressants, except Wellbutrin which does not work at all by itself. Wellbutrin is often an effective augmenter for other antidepressants.

Which antidepressant you use is a question of what your symptoms are, and what side effects you have to the medications. If nausea is a major problem, you can dissolve/suspend 30 mg of Remeron in 15 ounces of juice and drink one ounce every night (2 mg dosage). This takes care of the nausea most of the time. Refrigerate the remainder. Drink one ounce for 10 days and 1/2 ounce for the next ten (1 mg) and the nausea should be all gone. If diarrhea is a problem, use Effexor XR. If constipation a problem, use Zoloft. If you have no obsessionality, use Serzone. If sedation with the SSRIs or SNRIs is a problem, add on Provigil as 200 mg in the AM. 95% of the side effects are manageable.