Use of Effexor in the BPD - a new idea

by Leland M. Heller M.D.

Dr. Larry Siever described a subset of borderlines with chronic or frequent dysphoria (anxiety, rage, depression and despair), panic, generalized anxiety disorder and carbohydrate cravings. In my experience, these individuals are very difficult to treat because they are usually intolerant to Paxil and BuSpar, and often to other SSRI's like Prozac as well. It appears this is an additional neurological problem that responds to Effexor with Remeron. I'm starting to have some success using low doses of multiple meds, as is currently being done in the treatment of hypertension and diabetes.

Effexor 37.5mg to 75mg nightly for two weeks, followed by Remeron 30mg in the morning for two weeks seems to allow "regular" treatment without the "usual" side effects these individuals have. Prozac or other SSRI's are then tolerated, and the as needed meds Haldol, Tegretol, and then Risperdal are effective. Timing and sequence are important here as well.

No patient that I know has done well on Effexor alone. They may be better, but I've never seen a patient who did great on it. I define great as happy, elimination of chronic anger, energetic, enthusiastic and feeling terrific. Side effects are usually a huge problem with Effexor, particularly at the higher doses. The fatigue can be impressive.

There are some reports of success with Effexor and lithium. While this may work, I generally won't prescribe it because of lithium's side effects - particularly the impressive weight gain.

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