Q. I have been diagnosed with recurrent major depression and BPD. I am on a mood stabilizer (Divalproex) spelling?, and Effexor. I have been seeing a therapist at a local mental health clinic who sent me to a support group. While I was attending the support group the rule at the clinic is that you don't see your primary therapist. While I was in the support group, I started seeing a pdoc not associated with the clinic. Now that I am done with the support group, my therapist doesn't know if she can see me. I obviously feel abandoned and do not know what to do. I have had periods in my past, even while on medication, that I feel overwhelmed (frustrated, confused, emotional turmoil, being abandoned) and resort to self mutilation by way of cutting my upper arms with a razor. What medications can help relieve these feelings, because, I cannot seem to get the answers I need where I live?

A. The behaviors you mentioned should resolve with successful pharmacotherapy. If your Effexor dose is less than 300 mg/day, it is not enough. Effexor is probably the best medication overall if one looks at BPD symptom reduction. The others are good, but do not work in as high a percentage of patients. They may fit an individual patient better, however, and many like Serzone have fewer side effects (if they work).

Currently, I have my patients use Effexor as 300 or 450 mg of the extended release every morning. The Depakote is used infrequently because of the weight gain, tremors, and hair loss.