Can PMS Trigger BPD Episodes?

Written by Dr. Leland Heller

QUESTION:

Do you think PMS can trigger BPD episodes? My wife rages (more) consistently, under pressure and in the 10 days running up to her period. Perhaps the neuroleptics (e.g. Haldol) could be "increased" during these 10 days. The doctor is now trying Valium which I am objecting to.

DR. HELLER'S ANSWER:DR. HELLER'S ANSWER:

PMS is a major trigger of BPD dysphoria (anxiety, rage, depression and despair). It usually responds amazingly well to powerful water pills during that time. I usually prescribe Demadex (torsemide) with potassium for my patients. I go into this at length in "Biological Unhappiness." Prozac (fluoxetine) is absolutely necessary for someone with the BPD and PMS.

Benzodiazepines like Valium can actually make the condition worse. When a borderline goes into dysphoria they will do almost anything to feel better, which is the main reason for self destructive behaviors. They usually still fear consequences, however. Tranquilizers like Xanax and Valium cause them to lose that fear and the severity of self destructive behavior worsens. This was shown in an article from NIMH published in the Archives of General Psychiatry, February 1988. The exact quote was "...those receiving alprazolam (Xanax) had an increase in the severity of the episodes of serious dyscontrol."

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