Borderline personality, or bipolar?

Q: I have been diagnosed Bipolar II. I am not entirely sure what that means. As I read the information about BPD and Bipolar, I am unsure if the diagnosis is correct. I have been given Depokote(sp?) and a benzodiazapine (sp?), but don't want to start...mainly due to weight gain. How do I know if I am one or the other? Maybe I need therapy, not meds? I'm not sure. Thank you for any input on how to find an answer.

Dear Ms. R' --
You are asking about an important distinction -- important, at least, because depending on what label you get, you may get treated very differently (and I don't mean medications; rather, how much civility and respect you get can differ a great deal, unfortunately). 

However, the actual treatment options are beginning to look more and more alike: a specific cognitive-behavioral therapy for borderlines, which could probably benefit anyone with mood and behavior instability; and trials of various medications.  The latter used to be mostly antidepressants but more and more now it's mood stabilizers and the new generations of antipsychotics (for control of nightmares, dissociation, and out of control thinking). 

So you can see the point: which diagnosis you use is beginning to make less and less of a difference.  Try my more lengthy essay on this subject .

And remember, if you take Depakote at a dose below the point at which your appetite increases dramatically, you are very unlikely to gain weight (and conversely, if you go above that dose, you are very likely to gain); so you can try it with pretty low risk of weight gain if you lower the dose when your appetite takes off.   Such a plan makes it less scary to at least try it.

Dr. Phelps

Published February, 2001