Q. I have borderline personality disorder along with Major Depression; and at times have been psychotic. In the past year, I have been on Effexor (300mg), Risperdal (1-2mg), Tegretol, Serzone, Celexa, and Xanax at different times. I have attempted suicide 3 times. I briefly abused Xanax and alcohol, resulting in the most recent suicide attempt 3 months ago which led to a short time of being comatose.

During the resulting hospitalization, my doctor took me off of the Effexor (which I had been on for the entirety of the previous year) and put me on 20mg of Celexa. The Celexa didn't help at all, and without consulting my doctor, I quit taking all of my medications upon discharge.

It has been three months since this decision, and I have continued therapy 1-2 times a week. I told my psychologist of my decision to stop taking the meds immediately. He has followed me closely and feels that I am doing better. I have had some moderate stressors in this time and have handled them effectively.

I realize the severity of my illness and I do take it seriously. I am doing everything possible to get better and stay healthy (short of the meds). I have begun exercising, joined a support group, and am doing several other things to take care of myself.

I have an appointment soon to see my psychiatrist for the first time since the hospitalization. I will also resume taking college classes this month to finish my Bachelor's degree. I will be working full time and going to school full time.

Should I return to meds (even though I am doing much, much better for the first time in a year) just as a precaution against the Depression returning, especially in light of the added stress of going to school? Have you ever encountered this type of "remission"? I don't want to take medication if it isn't necessary, but I also don't want to set myself up for failure.

A. Great questions with no easy answers. While medications help many folks, they do not help everyone. Some even do worse on the medications because they (a) are not working, (b) have untoward side effects, and (c) can cause mental slowing. That said, you may just need more Effexor XR. I do not give up on it until I have used 600 mg per day. Likewise, Celexa usually does not work in BPD until you get to 60-80 mg/day, and sometimes more.

The illness is always there, but it does wax and wane in intensity for most folks. Stress definitely worsens function in BPD, so you may want to reconsider using medications. The archived letters on this site talk about doing and what to look for to indicate response. See if they apply, and talk to your doctor about your medications.