BPD and Lithium

QUESTION:

My ex-wife has been diagnosed as a borderline by some doctors and bipolar by others. She recently sent me some info stating that she was still taking lithium. She said that she never had the manic episodes that are associated with bipolar but that without the lithium she becomes depressed. Does this make sense? How could someone be called bipolar if they don't have manic episodes? Could the lithium be used for the BPD?

DR. HELLER'S ANSWER:

I agree with you. Bipolar can't be diagnosed without a mania or hypomania spell. Many individuals in my experience are diagnosed with bipolar who actually have the BPD, the bipolar diagnosis being given just on the basis of the mood swings.

Some reports show lithium may help, but I haven't seen any patients who liked it or thought it made a difference. It's best use is likely in combination with other medications. While it's possible she got depressed from the lithium, it's also possible she felt depressed DESPITE the lithium.

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