ADD, Bipolar and BPD

QUESTION:

Doctor Heller-

My 21 year old son has been recently diagnosed with the BPD The treatment is Risperdal. He is already taking Dexedrine and Effexor already for Add and Bipolar Disorder.  Been on DEXEDRINE for several years but began depression when he transferred from Jr. College to Texas A&M University. 1-99. Several manic episodes since.  But lows are the norm.  His grades remain good, but sense of doom and fear of failure are dominating his thoughts.  I am a recovering alcoholic and pothead (clean/sober-8yrs.4months). 

Son is very introspective and sensitive to begin with and the BP and BPD diagnoses have occurred during a 30 day span.  Should I take him out of school and get him home for immediate treatment or is RISPERDAL + DEXEDRINE + EFFEXOR effective or what?  Thank you in advance for you reply or questions.

DR. HELLER'S ANSWER:

That combination can be effective, but I prefer a different approach. All of his diagnoses need to be made, including whether he has panic disorder or not. I also believe strongly in using a mood stabilizing agent - especially Tegretol, although Depakote is reasonable - in treating borderlines who have bipolar. An SSRI such as Prozac or Paxil may be particularly effective in treating panic disorder coexisting with the BPD. Risperdal is effective, but side effects can be a huge problem, and long term safety remains a significant issue.

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