QUESTION:

Hello,

My 18 year old daughter has just been diagnosed with borderline personality disorder. She was on Prozac and that did not help--she recently attempted suicide.

A psychiatrist is seeing her now and has taken her off Prozac and she is currently on no meds. Is that advisable?

Thank you,
Can't Sleep Mom

DR. HELLER'S ANSWER:

While some individuals with the BPD can do well after they've successfully taken medication for a while and they are no longer under stress, one with the BPD doing poorly should be on medication. Prozac (fluoxetine) alone is not enough as it only works for part of the problem. The right Prozac (fluoxetine) dose will stop the unprovoked mood swings, chronic anger and irritability, emptiness and boredom. It will also reduce the frequency of dysphoric episodes (that can include suicidal behavior), but it will not reduce the intensity of those episodes. Tegretol and/or short term Zyprexa are in my experience the best emergency options. If the patient is already taking Prozac and Tegretol, one dose of Risperdal (usually 3mg) will stop BPD dysphoria in 24 hours. Once stabilized with Prozac and Tegretol, Haldol (haloperidol) will usually work in 10 minutes whenever the individual experiences dysphoria (anxiety, rage, depression and despair).

While practitioners may disagree on how to treat the BPD, the scientific literature and recommendations of some journals and societies definitely back the use of medication for the BPD.

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