BPD Chat Conference With Paul Markovitz M.D., Ph.D. - 6/28/00

We were extremely fortunate to have Dr. Paul Markovitz. provide a chat conference about the borderline personality disorder at the Borderline Personality Disorder Sanctuary.  Below are the transcripts. Dr. Moskovitz used the nick name of "DrM"

<DrM> if questions for me fire away 
<chameo> do u really think that meds are essential? 
<DrM> sometimes yes and sometimes no 
<VicHam> I'm on 30mg Remeron, 7.5mg valium, and just started 2.5mg Zyprexa 
<DrM> they are an option you should always use. Most need them 
<VicHam> when does the Zyprexa start to work 
<chameo> I have bpd but its always been stressed 2 me that bpd's shouldn’t take them <tearscorrode> and if you can't take meds...then what? 
<DrM> Usually in 6-10 days if it is the right stuff 
<VicHam> thanks 
<christy74> I am still confused on how I developed BPD 
<DrM> If you cannot take meds, it is rare. Most everyone can 
<lance37> am I going to be this for the rest of my life 
<tearscorrode> Sure if they want to get more sick.. 
<DrM> no. Meds and therapy will help a ton 
<chameo> is it not covering over important feelings that could be used in therapy? 
<DrM> BPD is a biological illness. Talking will not fix it. 
<DrM> Once the meds are in, talking helps 
<chameo> just bio? 
<tearscorrode> Paxil gave me a medical condition that resembles tourettes ..so more meds is not an option 
<bingle1> if its biological then why are our feelings so messed up? 
<Skreee> bingle1: because the brain is an organ like every other organ 
<VicHam> Dr, you suggest high doses on antidepressants, any bad side effects? 
<DrM> Paxil is a poor choice for BPD overall. Try Serzone if you do not have OCD 
<DrM> All meds have side effects. You try to get one that helps more than the illness hurts. 
<DrM> Sometimes you are lucky (usually) and the side effects go away 
<VicHam> what's your recommendation on dosage of Remeron? 
<DrM> Remeron makes one gain weight, but I usually dose it between 60-120 mg at bed 
<chameo> how do u explain the patterns we repeat over and over if it isn’t all learned from our experiences? <lance37> I’m on Effexor 75mgs, navane 5mgs, Depakote 750mgs. and cogentin 2mgs but I don't feel they work and I’ve been on many different combos of drugs <DrM> If it was learned, you would not do it. All else you do you correct. Heck, you would still be wetting your pants if you did not learn it was unacceptable. 
<christy74> I was put on Remeron today but was told it could probably help my anxiety is that true? 
<electromix> DrM, I have bipolar and borderline, at the moment they have me on sodium valproate, but I am pretty sure I need an antidepressant to go with it .. Zoloft did nothing for me when I tried it (if anything it less to an OD) have you any suggestions for which antidepressant I should put myself on ? 
<DrM> Things one can change, you do. You cannot change BPD because it is biochemical and not amenable to thought therapy or talking 
<electromix> -s 
<chameo> its not easy to unlearn things 
<DrM> Let me lay down a few thoughts I always go by 
<DrM> First, BPD is biological. No one would act that way if they could prevent it. We all avoid pain, and BPD is painful 
<DrM> Second. Meds are imperative. If it is biological, you have to treat what is physically wrong. 
<chameo> what’s the point in therapists if it's all bio, just m.d's would do to get the right drugs then surely? <DrM> Then, like any other medical condition you do rehab therapy. 
<DrM> Therapists are like physical therapists after a leg injury or heart by pass. 
<DrM> Dr. fixes what is physically wrong and the therapist rehabs 
<VicHam> my doctor doesn't believe in your high doses 
<VicHam> Remeron only at 30 mg 
<DrM> The doses are all in the literature. One should follow what is printed. Low doses do not work, regardless of what your doctor believes 
<Tim> Most Drs. and therapists unfortunately are not aware of how to treat the BPD. As a result, many people are left to suffer. 
<VicHam> guess I don't have one, or, should I doctor-shop? 
<DrM> Remeron may not be the right med. But it never has worked in my BPD patients at 30 
<bingle1> Can the bpd affect premenopause? I am starting that and I feel even worse emotionally than usual. 
<DrM>Tim and I may try to get a list together of competent doctors for treating BPD. It is hard to do 
<lance37> why when I get every thing I think I want I then go and destroy what I created 
<DrM> BPD will effect premenopause 
<christy74> Dr is I was told that Remeron could help my anxiety is this true? 
<DrM> Yes. 
<VicHam> what will the Zyprexa do? 
<DrM> Zyprexa will reduce anxiety, depression, and psychosis if it is the right med for u 
<VicHam> thanks 
<lance37> why when I get everything I think I want I go ahead and DESTROY it 
<DrM> The Zyprexa is close to Serzone, probably, and Serzone is a good option if the Zyprexa gets you too sedated or weight gain 
<VicHam> I have PTSD, BPD and drug-resistant depression 
<chameo> we have feelings for a reason and they are brought up for a reason other than it being a chemical process-imo 
<DrM> U would destroy it even if you got nothing. U are rationalizing a biological behavior in nonbiological thinking 
<VicHam> Serzone had too many side effects for me 
<DrM> Surprised about Serzone. Did u use it as an all bedtime dose? 
<VicHam> no, was up to 500mg 3x day 
<babybj> I have Serzone 2 times a day....600mg all up 
<DrM> Serzone should all be taken at bed 
<christy74> Dr. Has there been any cases found where one has not been able to be help by Medications? 
<VicHam> Serzone=bad complexion & joint pain 
<DrM> Sure. Just like diabetes and hypertension and asthma. Meds not helping does not mean it is not biological 
<lance37> why does heroin make me feel normal 
<_ellie_> can bpd NOT be biological? 
<DrM> It does not. It makes you high 
<christy74> What do you suggest to those who can't seem to get help by meds and therapy doesn't seem to be working? 
<DrM> There are a lot of things if meds and therapy are not helping. 
<babybj> food helps me 
<babybj> I found 
<lance37> tell me I need to know 
<DrM> For example, you can get into research studies for depression with new, unreleased meds. 
<TimLPN> Even though in the end the result is biological, can BPD start off being caused by abuse?? 
<bingle1> I take 400 mg wellbutrin sr and seroquel. Why do I seem to need both to control bpd? 
<DrM> We do not know what causes BPD. 
<chameo> I know hundreds of people with bpd who actually get better without meds and they r from a therapeutic community based treatment, do u know of these places and what do u think of their no meds policy? 
<DrM> Like diabetes, it may represent a common behavior of many disease 
<lance37> is there any kind of medical test to determine if one has bpd 
<DrM> Thus, there is more than one treatment, and multiple meds may represent a way to cover your particular form 
<babybj> could it be just simply an inherent gene? 
<DrM> No medical tests yet for BPD 
<_ellie_> can bpd NOT be biological? 
<VicHam> I was adopted, and abused . . who knows where the BPD came from 
<DrM> Probably is genetic 
<lance37> how can one be sure you have it then 
<babybj> I see it in me mum and sister 
<Tim> I personally would not attend any treatment program for my BPD if they have a no med policy. It would tell me that they are up to date on treatment. 
<DrM> Again, most people avoid painful things. I doubt abuse causes bpd 
<DrM> I agree with Tim 
<christy74> although it is not the belief. who thought of the phrase "between neurotic and psychotic"? 
<VicHam> do you find adopted children with BPD high incidence? 
<DrM> If it looks like it, smells like it and tastes like it, chances are it is 
<chameo> I did this year of treatment and I’ve changed a lot 
<DrM> BPD is higher in adopted kids. 
<babybj> hmmm 
<tearscorrode> there are many different opinions on abuse vs. bpd 
<taisto> I’m adopted <DrM> what kind of treatment chameo 
<bingle1> but if its genetic then perhaps its higher because birth parent has bpd 
<chameo> henderson therapeutic community in London 
<lance37> how do you feel about DBT 
<tearscorrode> There is much to be learned about BPD 
<DrM> I think BBT is the best form of therapy currently available for BPD 
<Woodsey> chameo there’s a similar scheme in aberyswith in wales 
<TimLPN> Do you think other cognitive therapies help also?? 
<DrM> all treatments for BPD will improve with time. We are getting better 
<chameo> they are opening two new ones this year in birmingham and crewe it is a government funded specialist resource because it works 
<babybj> how do our chemical makeup switch so quickly , though? 
<DrM> yes I do Tim. DPT just has the best documentation. Like meds, different therapies fit different people. One type will not fit all 
<lance37> is scratching and cutting the same kind of thing (reason) 
<weepippo> how does the dissociative affects of bpd fit in to the picture? 
<DrM> Babyj, I do not know. It does. Same thing could be said about seizures or asthma. Comes on all of a sudden 
<babybj> they can site them though 
<DrM> I view dissociative episodes as an anxiety symptom. It happens in panic too 
<babybj> brain eeg's 
<DrM> no test yet for BPD 
<babybj> anxiety? 
<DrM> Yet, DBT is dialectical behavioral therapy 
<_ellie_> thanks 
<DrM> no tests for any psych disorder 
<lance37> is scratching and cutting the same type of thing (reason) 
<chameo> I believe that dissociation is bio but triggered from environment, what can u do to get back with it? 
<tearscorrode> Is DSM a way of diagnosing BPD or is it just a way of labeling someone with it? because doesn't a diagnosis indicate what caused the illness? 
<babybj> DSM? 
<bingle1> good question tears. 
<Tim> Diagnostic Statistic Manual 
<DrM> Diagnostics and statistics manual (DSM) has all psyche diagnoses. 
<babybj> thanks Tim 
<babybj> and doc 
<tearscorrode> (Doctors use DSM guidelines to give illnesses a "name") 
<DrM> well put 
<babybj> k 
<_ellie_> lance had a good q 
<lance37> I rip all my scabs off my body and get sores without remembering how they got there is that the same as cutting 
<DrM> yes, same as cutting. Does it feel good? 
<lance37> yes it feels great 
<tearscorrode> that's what I thought... 
<DrM> Great article in June 5 US magazine about famous people that cut. 
<Tim> Dr. have you heard of Remeron making anyone psychotic? 
<christy74> In an incident that happened a few months ago How could I cut all over myself and not even realized I had done it until afterwards? 
<DrM> No, but it could Tim. Any of the meds can do bad things too 
<chameo> woodsey-did u read about new treatment in b'ham 
<bingle1> I have never cut or scratched etc and that seems to be a big indicator of bpd. why don’t I do that and yet still have bpd 
<Tim> thanks 
<DrM> Do not need to cut to have bpd. It is a symptoms. One of many. 
<DrM> You do not need vomiting to have flu. Some do, some do not 
<TimLPN> Is cutting a good indicator of the BPD??