QUESTION:

I have been diagnosed with clinical depression and have been on anti-depressants since 1993. I am 50 years old and had a very mild heart attack and 5 by-passes in July 1998. Depression followed and Paxil was increased from 30 to 40 mg. Over the last 10 years, I have numerous incidents of angry outbursts, rage, and inappropriate car driving usually associated with work stress plus physical tiredness.

About 6 weeks ago, I began overreacting to minor problems, felt increased moodiness, memory deterioration, low energy and increased need for sweet foods to boost energy. For a month, my specialist increased my Paxil to 60 which decreased my energy, made me sleep during the day but it did calm my feelings and I felt more emotionally stable. Under his direction, I have just reduced to 50 mg for 3 week trial.

I have just discovered Bpd; read a book and reviewed your web site. BPD seems to explain my unacceptable behavior, sporadic rage and mood swings. Reckless driving, fear of abandonment, binge eating, too much anger (usually out of control verbal rage), binge spending and Who am I, What do I want?? All apply to my life over the past 15 months. Losing it under stress exactly describes my anger bouts and sporadic rage. (during these events, I just "completely lose it". It is like a hot button is pressed and I spring into action. My out burst and damage is done in just seconds up to 2 minutes) I then get very blue, depressed and spend much time alone beating my self up verbally and trying to figure out how to prevent this events.

I know that I need knowable and experienced help.

Neither of my 2 doctors have every mentioned BPD One is General practitioner other is psychiatrist.

DR. HELLER'S ANSWER:

There are many links, although open heart surgery doesn't cause the BPD, although post operative depression is not uncommon.

Depression and BPD can both cause or at least contribute to coronary artery disease for many reasons, including effects on the immune system and circulating blood chemicals.

Stress like open heart surgery can worsen the BPD and depression.

Another possibility is brain damage from the procedure. Stroke is a risk during open heart surgery, as is low oxygen. There are documented cases of BPD from head injuries and brain infections, so I see no reason that the above complications couldn't cause the BPD.

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