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

Page Five

<snowonthemountain> could you explain what you mean please? 
<twisted6> Dr M can you say than you see us as drug free ever and therapy free? 
<Opalene> I think that there is definitely something missing from a solution to BPD when so many of us complain that the meds are not working in the long run 
<weepippo> yes 
<drewbug> opalene... good point... 
<DrM> Snow, if you need to have a job, then obsessively looking for the perfect one is not good. Recovery takes time, and you have to slowly but surely do it. 
<olsurfpax> my meds seem to be working 90mgs Paxil 
<ibtawny> I was diagnosed by a previous psychiatrist; this one thinks it is inaccurate, but I think the symptoms are definitely there Who do I trust? 
<Gillian1> Dr M, do you see bpd in any ethnic group more than others, are men misdiagnosed with stress syndrome? 
<DrM> I wish everyone with BPD was well. Until 1986, the illness was largely ignored. We have a long way to go, but at least we are trying to do something now, and not ignoring this problem 
<anast> DRM, why don’t hospitals get paid for a bpd dx? 
<DrM> BPD is three to one female to male. Less in Asian population than European 
<ForestLobo> Dr. M. Have been trying to stabilize and control my bpd for 10 yrs. It still controls me. Nothing works. Is there anything new in tx? 
<DrM> Forest, there are a number of new things coming out soon. Substance P antagonists may help. 
<wopsielou> DR M I just sliced my leg out of anger why can't I stop cutting 
<Opalene> Men act out their feelings more than women. Women keep it bottled up 
<DrM> Perhaps opa, but no one is sure. 
<ibtawny> Is there a known genetic link to bpd? (I see traits in my daughter...) 
<_ellie_> yes there is ibtawny 
<DrM> Yes, ib. there is 
<Opalene> How do you feel about Cytomel (T3) Many BPD'rs respond to it favorably 
<DrM> Benzos are not helpful. They reduce anxiety but not much else 
<DrM> Cytomel is good for energy and as an antidepressant augmentor. It is worth a try if you need it 
<drewbug> what's the deal with Wellbutrin? should I ask my pdoc about it? 
* anast is not asking anymore questions! 
<Gillian1> Thank you for all your time doctor but I do have to go, you were most helpful 
<DrM> drew, I have had little luck with it as a sols agent. It is great as an add-on for energy and concentration and weight reduction 
<drewbug> I could use energy... thanks, I’ll ask 
<anast> I could use it for weight loss 
<DrM> Wellbutrin also causes shakes and anxiety. Provigil may be better 
<wopsielou> DRM why do I cut my self out of anger 
<DrM> cutting feels good. That is why folks do it. 
<ibtawny> Dr M: does bpd cause chronic exhaustion/paralysis like depression? 
<snowonthemountain> feels good?!? 
<DrM> it can ibtawny 
<twisted6> yes snow it releases a chemical 
<ibtawny> thx 
<DrM> Cutting feels good, or you would not do it. 
<Jedic> what do you do if you are embarrassed by trying any kind of treatment? 
<anast> DR M I lost 50 before my dx, I cant seem to do it now, I sabotage myself too much, what can I do? This is damn frustrating 
<anast> I know I have gained 20 of it back and it pisses me off 
<DrM> Jedic, if you are embarrassed you have a choice of staying sick or getting worse with out treatment. That would not make sense 
<_ellie_> I am wondering what your take is on adolescent bpd dx, DR.M. My father is a psychologist and says that bpd cannot be properly dxed until after 18. 
<DrM> anast, try adding on Wellbutrin or Provigil for weight loss if the other symptoms are under control 
<anast> I take wellbutrin already, it hasn’t helped 
<DrM> ellie, it technically cannot be diagnosed until 18, but it is obvious when it is there 
<anast> that’s why they put me on Neurontin 
<DrM> I would treat kids aggressively. Once you are 18, and the illness has set in, its is harder to catch up 
<DrM> Neurontin will cause increased appetite. 
<DrM> Try Topamax instead. It causes weight loss 
<snowonthemountain> what does Topamax treat sx wise? 
<DrM> about 1/3 for people on topiramate (Topamax) lose weight 
<Freaked> what drugs put weight on? 
<TimLPN> mood stabilizer 
<Freaked> I’m going on meds soon and I don't want to get fatter 
<DrM> Topamax is an anticonvulsant. It stabilizes mood, reduces depression and helps with anxiety 
<drewbug> freaked... discuss that with your doc when you get one... mention it with your other concerns 
<twisted6> DrM what medicine do you recommend to stop visual thoughts? 
<DrM> Topamax is similar to Tegretol, Depakote, Lamictal\ 
<DrM> Visual thoughts are tough to answer. If you actually see things, and antipsychotic. If they are in your minds eye, may be better off with an increased dose of antidepressant. 
<Opalene> How do you get a doctor to actually listen to your suggestions. They have their own way of treating patients 
<snowonthemountain> so if I am on desyrel and don't feel it is effective enough could my doctor add the Topamax as a augmenter? 
<DrM> Yes Snow 
<westongirl> do you have any suggestions for a mood stabilizer for someone who has ADHD and is on Ritalin 
<DrM> Opalene, you keep looking if you are not getting better. That is why we need to get a network of good treating doctors for BPD organized 
<Skreee> hi guest 
<ForestLobo> Dr. M. Any known connection between Migraines and BPD? My pdoc has added Depakote for relief. 
<DrM> Great question Forest. We did work on this. Same chemical that treats BPD will treat migraines. The are linked 
<Opalene> HMOs do not make it easy to "keep looking" 
<_ellie_> Is there a med good for BPD and OCD both? 
<DrM> HMOs are an evil 
<twisted6> lol dr m 
<anast> the devil incarnate DRM 
<DrM> ellie, all sris and snris will work. I like Effexor best 
<westongirl> dr m is there a med for depersonalization that goes with Ritalin 
<drewbug> snris? 
<ForestLobo> Dr. M. Migraines accelerated to almost constant on Effexor. 
<twisted6> :( forest had a killer one the other day 
<DrM> Slow down. West, the Ritalin may make it worse, so Provigil is better in many 
<Tim> Opalene, as borderlines, most of us have to fight hard to get better. Many of us have to switch Drs. in order to find a good one. We need to start demanding treatment and many times we ourselves need to educate our own Drs. It is hard having the BPD at this time with so much misinformation and total lack of information. We are the pioneers. And yes, HMOs are indeed evil. 
<DrM> Opalene, you can look for another doc in the system 
<anast> Provigil is a ssri? 
<westongirl> thanks Dr. M 
<drewbug> thanks Tim... what's it stand for though? 
<DrM> Forest, it may be a bad fit of a med or maybe you just need more Effexor 
<DrM> Provigil is a med for narcolepsy. It is just a great augmenter. 
<DrM> SNRIs are Effexor and Effexor XR 
<anast> <----is planning to have a rage when she sees her pdoc next, see what it feels like 
<ForestLobo> Was a bad fit. 
<westongirl> do you mean just take the Provigil and not the Ritalin 
<DrM> talk to your doctor west, it is one option. 
<westongirl> thanks Dr. M. 
<TimLPN> Drew its in the ask the Dr questions, but its a SSRI and TCA so it will help with the BPD and Anxiety 
<Tim> I always advise people who have a doc that doesn’t have a clue but is willing to work with you and not let their ego get in the way, to print up stuff from the website. Study the articles. Study the Ask the Dr. section. Bring that info in to your doc. 
<DrM> I need to go soon. I will try to do this at least every few months and will let Tim know the times. Bye all.