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Monday, March 10, 2014
Bipolar Disorder (Children and Adolescents)
Borderline Personality Disorder and Depression Treatments
I was diagnosed with borderline personality disorder when I was around 16, and was treated it for it for about a year and a half, when it seemed I`d grown somewhat out of my symptoms (mainly temper) - I had been given lithium for a time, but mostly group and private therapy. I am now 32, and a couple years ago I began taking Paxil CR for depression - long overdue according to my loved ones. However, about a year into a treatment it seemed that there was little effectiveness, even after increasing the dosage. I had also started frequently having violent thoughts. Never anything I would (as far as I know) act upon, but more to satiate the anger I would frequently get distracted. They would sort of be vignettes of what I might do to that person that just passed me on the road, or if the police pulled me over, or my boss angered me, etc. I finally went to a psychiatrist. She started me on lamictal, and am currently on a 200mg/day dose. It appeared to help more than the paxil at first - no temper tantrums, only occasional thoughts - but recently I have been having *severe* outbursts of anger and losing my temper, as well as a huge increase in violent thoughts. Stress has increased somewhat in my life - but at the same time during this I`ve managed to quit smoking after 14 years. I am well past what I would think would be any sort of serious withdrawal stage (been 2 months now), but I may as well not be taking my lamictal - it appears to have no effect - the only reason I still take it is for the potential for the serious `rash` my doctor told me about when ramping the meds up or down. I also appear to have developed severe difficulty falling asleep - only music can really help - where I used to be able to be out like a light in under 5 minutes. Before I started on the lamictal, we discussed my recreational drug history - from age 18 or 19 till about 29 I was more or less a regular marijuana user - she said that could very well be why I didn`t have a lot of trouble with my disorder and my temper. I also have done ecstacy a few times (less than 5) and yet she said it was possible that that could have caused meds like Paxil to have greatly reduced effectiveness. I am moving up my scheduled visit to my doctor to reassess what I need, but a different view would be appreciated.
Hello and thank you for your excellent question.
Unfortunately, I can't answer your question specifically because my specialty is childhood and not adult bipolar disorder. However, what I would suggest any person does who has queries with their medication is to talk with their prescribing M.D. about their concerns and what has worked and has not worked in the past.
I also think it will be very important for you to obtain an updated diagnosis from your doctor to guide you and him/her in choosing current and future treatment decisions. If the diagnosis is bipolar disorder, an excellent self-help book is "The Bipolar Disorder Survival Guide: What You and Your Family Need to Know" by David J. Miklowitz, which you could use with a therapist in therapy.
If borderline personality disorder, I'd suggest asking for a therapist who specializes in "Dialectical Behavior Therapy" (DBT) by Marsha Linehan, Ph.D., which is the evidenced-based practice for this condition. An excellent self-help book for people with borderline-personality disorder is "Reinventing Your Life" by Jeffrey Young, Ph.D. and Janet Klosko, Ph.D.
Hope that helps! Best wishes.
Nicholas Lofthouse, PhD
Clinical Assistant Professor of Psychiatry
College of Medicine
The Ohio State University