QUESTION:

Dear Dr. Heller,

I get hit out of no where with waves of grief as if someone close to me has just died - alternating with the dysphoria. I can not take this anymore. I was just told by the head of the trauma center here that new studies show that BPD is another name for complex PTSD (i.e. they are one and the same thing). I also have recurrent major depression. I don't like these episodes of intense grief. How do I get rid of these if I don't have all the memories yet? I am constantly feeling suicidal.

DR. HELLER'S ANSWER:

There are many similarities between PTSD and the BPD, but they are clearly separate entities that commonly co-exist. PTSD apparently has a strong association with an elevated serotonin #2 receptor and responds well to Remeron (Remeron blocks that receptor). Because many individuals with the BPD have PTSD, SSRI medications like Zoloft have been successful in treating PTSD. SSRI's, Tegretol and neuroleptics work for the BPD. There are individuals with PTSD who do not have the BPD, and vice-versa. There are also cases of BPD from head trauma and brain infections. There is also a 50/50 correlation between BPD and ADHD. Many borderlines were not traumatized as children.

"Complex PTSD" is not an official diagnosis, and is likely a term that those involved with PTSD choose to describe the BPD without using that diagnosis.

BPD symptoms treated by Prozac are unprovoked mood swings, chronic anger, emptiness, boredom and emotional pain (feeling like one's friend died). Higher Prozac doses are sometimes necessary to stop these symptoms.

Those with the BPD experiencing grief, suicidal thoughts and chronic or frequent dysphoria (anxiety, rage, depression and despair) need Prozac combined with Tegretol (patients do better if the Prozac is taken for a week prior to adding the Tegretol). Sometimes temporary use of an atypical antipsychotic such as Seroquel is needed. Geodon is an alternative and has additional PTSD effects by also blocking that serotonin 2 receptor.

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