Q. I am borderline and bi-polar. I take Effexor XR 150 mg at bedtime, Depakote 1500 mg a day, Paxil 20 mg at bedtime, Vistoril 150 mg a day, Risperdal 3 mg twice a day. I have a history of polysubstance abuse and relapsed. Two days ago I stopped using. My marriage has been a mess for the past year, (even while not using).

I have hit, punched, shoved, screamed anything I could think of that would hurt my husband. He has done exactly the same thing to me. I live in PA and any therapist (2) that I have had, know almost anything about Borderline Personality Disorder. I have only my husband and my dog. I feel like leaving my marriage but then again I don't. I completely obsessed about staying or leaving my husband for 4 months and a week ago I was put on Paxil 10mg at night and then bumped up to 20 mg at night. I'm not obsessing as much about staying or leaving my husband . But I'm still mixed up about what to do or where to start. I'm also in trouble. I go to court in Dec. for Terrostic threats and resisting arrest. In March, my husband and I where hitting each other and it got out of control. My Therapist told me three weeks ago that he didn't want to make an appointment. I haven't seen him and he wasn't much help.

  A. If you can get to Western Psychiatric in Pittsburgh, they have a great program for borderlines. Paul Soloff, MD is one of the most knowledgeable doctors in the world on BPD.

Failing this, ask your doctor about increasing your Effexor XR to a reasonable level in the 300 (rock bottom minimum) to 450 mg range. Also, most folks take Effexor in the AM, not PM. If the Effexor works, you can get off almost everything else under your doctor's guidance.