QUESTION:

Dear Dr. Heller,

I'm a 35-year old man, BPD, severely depressed and suffering from attention disorder. I'm trying to avoid alcohol, but unfortunately I'm frequently having relapses that can last 3 to 4 days. I really shouldn't, I know. I'm taking 300mg of Effexor and my therapist wants to increase to 450mg, along with Tegretol and Campral. My medical doctor says my liver already has suffered too much and according to him, taking Effexor makes this problem worse. He's proposing citalopram (commercialized as Cipramil in Europe) - if it is as effective in treating BPD/ADD as it is in treating depression. The three of us would appreciate your opinion.

DR. HELLER'S ANSWER:

It's unlikely that any of these medications are more dangerous to your liver than continuing to drink alcohol, and any decisions need to be made with this idea in mind.

For Effexor to be effective in BPD treatment, very high doses need to be used in the 450-600mg per day range. Side effects can be a problem at this dose. I've treated many borderlines who came to me on this high dose regimen. They all did much better with the combination of fluoxetine (Prozac) with Tegretol. Citalopram (Celexa) is usually my second choice when an individual has a true allergic reaction to Prozac. I much prefer Prozac.

I'd also highly recommend doing my screening test, because treating all your diagnoses is a key component to successfully treating the BPD. Many individuals with the cognitive generalized anxiety disorder "treat" this diagnosis with alcohol.

I don't know enough about Campral to make a recommendation, except if it works continue it! It's not available in the US, and works like Naltrexone to reduce alcohol cravings.

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