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Written by Dr. Leland Heller
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May 02, 2007 |
A + A - RESET
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Page 1 of 4 2006
Borderline Personality Disorder (BPD):
1) Many individuals have restless legs syndrome. While iron deficiency is often the problem, and the most likely problem in menstruating females, it's not always the case. Sometimes antidepressants - including SSRI's - can be the cause, although usually it's a dopamine phenomenon in the muscle control part of the brain. The medication Requip (ropinirole) works for most individuals, but can make many borderlines worse - likely by raising dopamine in the trapped, cornered, wounded animal part of the limbic system. These individuals need to be treated with iron, and if unsuccessful with nighttime benzodiazepines like lorazepam or clonazepam. My experience has been approximately 60% of borderlines treated with Requip (ropinirole) get agitated and have to stop the medication.
2) There has been some renewed interest in the scientific community regarding the biological basis for BPD symptoms. The "G protein beta 3" has different types called "alleles." The "T allele" has been associated with self-mutilation in individuals with childhood abuse and BPD. Some work is being done on dopamine receptors as well, which is particularly exciting because of the success borderlines have using Haldol (haloperidol) on an as needed basis and the likelihood of dopamine dysfunction as a part of psychosis and dysphoria (anxiety, rage, depression and despair).
3) As mentioned in previous updates, Topamax (topiramate) can make borderlines worse. It can be so profoundly effective in reducing or eliminating migraine headaches that it's often worth a trial, sometimes taking it at the same time as Tegretol to reduce the risk of behavioral and anger/rage problems. Approximately 70% can't take it.
4) Something I emphasize to new BPD patients is the neurological basis of their disease. I tell them that there are times when they are sweet, loving and kind - that's who they really are. The rest is a neurological disease than can be treated medically.
2005
Borderline Personality Disorder:
1) While anti-epilepsy medications like Lamictal (lamotrigine), Trileptal (oxcarbazepine) and Topamax (topiramate) show some benefit in small studies, in my experience they still aren't as effective or as consistent as Tegretol (carbamazepine). Topamax (topiramate) is a double edged sword - while it works for some, it makes others very hostile and self destructive. Its advantage is the weight loss and reduction or elimination of migraine headaches. I have used it successfully in combination with Tegretol.
2) Zyprexa (olanzapine), particularly in combination with Prozac (fluoxetine), is very effective. It's extraordinarily expensive and many patients complain that they "don't have feelings." The problem is that it can cause massive weight gain (25 to 100 pounds) and diabetes.
3) My dysphoria (anxiety, rage, depression and despair) instruction sheet is still available at http://www.biologicalunhappiness.com/dysphori.htm. Sometimes SSRI antidepressants like Prozac (fluoxetine) can cause a neurotransmitter imbalance that causes low energy, a lack of pleasure and the "blahs." This is not the same as dysphoria. It is not associated with suicidal thoughts and it persists. Wellbutrin (buproprion) usually makes this go away in 1-2 weeks and I usually only prescribe it for a month or so.
4) I very rarely prescribe antipsychotic medication for chronic use, but if I do Abilify (aripiprazole) is the one usually prescribed primarily because of its low side effect profile (it doesn't cause weight gain).
5) A number of studies showed that the BPD has a biological basis (or at least significant biological abnormalities). They can be found at http://www.biologicalunhappiness.com/hippocampus_BPD.htm.
6) I have found over and over again that it's the comorbid conditions (what else is wrong) that defines how well an individual with the BPD will do. Prozac (fluoxetine) will stop the unprovoked mood swings, chronic anger, emptiness and boredom. Tegretol (carbamazepine) can stop chronic dysphoria (anxiety, rage, depression and despair) and dissociation. Intermittent dysphoria csr=1-1/qid=1155417474/ref=pd_bbs_1/103-3646553-3312606?ie=UTF8an easily be treated. For most individuals with the BPD the actual taking of pills is the easy part, it's convincing oneself that he/she should be treated that's the hard part. That's why character issues and spiritual issues are so important and can't be left out of any BPD evaluation or treatment plan.
7) Two books I'm recommending a lot lately are "Looking Out for Number One" by Robert Ringer (available very inexpensively at Amazon.com) and "Are You As Happy As Your Dog?" By Alan Cohen. I've found that many individuals find it easier to learn from their pets than from people. The latter book is hysterical, poignant, inexpensive and worth having at home.
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Last Updated( Nov 06, 2009 )
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reviewed by: Harry Croft, MD
Psychiatrist, HealthyPlace.com Medical Director
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