Further Options for Me?
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Q:  Further Options for Me?

I am bipolar 2 wirh borderline personality disorder.M y Dr. told me there is nothing more that can be done for me. I has overdosed many times. I am depressed a lot. My manic are just enough to get somethings done arreound the house I have four children at home, ages 19,18, 15, 10. I want to go back to school I tried 3 time unsuccessfully.  I tried all the mood stablizers.I cn't remain in the state of non functional ability.It feels like my world is just spining an won't stpo

Dear Kathy -- 
You are like quite a few folks in my practice, in that you have tried a lot of stuff and your symptoms continue and are severe.  But it's rare that I find myself without some further option to try (e.g see my little essay on
hope; and my little essay on bipolar and borderline while you're at it).  If you haven't tried combinations of three mood stabilizers at once, that should definitely be done, and that leads to quite a few combinations.  

And any medications or combinations that have been tried in the past with an antidepressant around at the same time should probably be tried again as the antidepressant can "keep them from working" by causing continued cycling (most folks like you have been on antidepressants for years and many of their mood stabilizer trials have been done while antidepressants were in the picture).  Notice that I haven't even mentioned the new-generation antipsychotics, which definitely have helped some folks like you (although the weight gain on Zyprexa can make one wonder if it was really worth it, sometimes; there are some disadvantages to each of these but perhaps not as much disadvantage to you as continuing to have symptoms). 

Then there's dialectic behavior therapy, which is really hard to come by in it's formal form, so I would doubt that you've had a really official version of that.  See more on that in my little borderline essay, linked above.  

You can see that the bottom line is that it's pretty hard to run out of alternative treatments to try and I've definitely had the experience of trying a bunch of stuff then hitting on something good.  One of my most difficult patients, previously diagnosed as "borderline" also, just had a very nice (and absolutely clear cut) response to verapamil, rarely used but perhaps worthy of more respect than it gets (certainly it's getting more respect from me after I saw what it did for this particular woman).  Your doctor may be understandably frustrated and tired of dealing with your symptoms just as you are; and at the same time some low-expectation pressing on with rational additional trials of combinations of things is what I do when I feel like that.  Good luck trying. 

Dr. Phelps


Published April, 2002


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