Borderline Personality Disorder Chat Conference:

Guest Speaker:  Paul Markovitz M.D., Ph.D.  6/28/00

Dr. Markovitz:

if questions for me fire away 

chameo: 

do u really think that meds are essential? 

Dr. Markovitz:

sometimes yes and sometimes no 

VicHam:

I'm on 30mg Remeron, 7.5mg valium, and just started 2.5mg Zyprexa 

Dr. Markovitz:

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? 

Dr. Markovitz:

Usually in 6-10 days if it is the right stuff 

VicHam:

thanks 

christy74: 

I am still confused on how I developed BPD 

Dr. Markovitz:

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.. 

Dr. Markovitz:

no. Meds and therapy will help a ton 

chameo:

is it not covering over important feelings that could be used in therapy? 

Dr. Markovitz:

BPD is a biological illness. Talking will not fix it. 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? 

Dr. Markovitz:

Paxil is a poor choice for BPD overall. Try Serzone if you do not have OCD All meds have side effects. You try to get one that helps more than the illness hurts. Sometimes you are lucky (usually) and the side effects go away 

VicHam:

what's your recommendation on dosage of Remeron? 

Dr. Markovitz:

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 

Dr. Markovitz:

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 ? 

Dr. Markovitz:

Things one can change, you do. You cannot change BPD because it is biochemical and not amenable to thought therapy or talking 

chameo:

its not easy to unlearn things 

Dr. Markovitz:

Let me lay down a few thoughts I always go by 
First, BPD is biological. No one would act that way if they could prevent it. We all avoid pain, and BPD is painful 
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? 

Dr. Markovitz:

Then, like any other medical condition you do rehab Therapists are like physical therapists after a leg injury or heart by pass. Dr. fixes what is physically wrong and the therapist rehabs 

VicHam:

my doctor doesn't believe in your high doses 
Remeron only at 30 mg 

Dr. Markovitz:

The doses are all in the literature. One should follow what is printed. Low doses do not work, regardless of what your doctor believes 

Patty:

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? 

Dr. Markovitz:

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. 
Patty and 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 

Dr. Markovitz:

BPD will effect premenopause 

christy74:

Dr is I was told that Remeron could help my anxiety is this true? 

Dr. Markovitz:

 Yes. 

VicHam:

what will the Zyprexa do? 

Dr. Markovitz:

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 

Dr. Markovitz:

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 

Dr. Markovitz:

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 

Dr. Markovitz:

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 

Dr. Markovitz:

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 

Dr. Markovitz:

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? 

Dr. Markovitz:

 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? 

Dr. Markovitz:

There are a lot of things if meds and therapy are not helping. 

babybj: 

food helps me I found 

lance37:

tell me I need to know 

Dr. Markovitz:

For example, you can get into research studies for depression with new, unreleased meds. 

Tim:

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? 

Dr. Markovitz:

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? 

Dr. Markovitz:

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 

Dr. Markovitz:

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? 

Dr. Markovitz:

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 

Dr. Markovitz:

Probably is genetic 

lance37:

how can one be sure you have it then 

babybj:

I see it in me mum and sister 

Patty:

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. 

Dr. Markovitz:

Again, most people avoid painful things. I doubt abuse causes bpd 
I agree with patty 

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? 

Dr. Markovitz:

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 

Dr. Markovitz:

BPD is higher in adopted kids. 

babybj:

hmmm 

tearscorrode:

there are many different opinions on abuse vs. bpd 

taisto:

I’m adopted 

Dr. Markovitz:

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 

Dr. Markovitz:

I think BBT is the best form of therapy currently available for BPD 

Woodsey: 

chameo there’s a similar scheme in aberyswith in wales 

Tim :

Do you think other cognitive therapies help also?? 

Dr. Markovitz:

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? 

Dr. Markovitz:

yes I do Tim. DPD 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? 

Dr. Markovitz:

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 

Dr. Markovitz:

I view dissociative episodes as an anxiety symptom. It happens in panic too 

babybj: 

brain eeg's 

Dr. Markovitz:

no test yet for BPD 

babybj: 

anxiety? 

Dr. Markovitz:

Yet, DBT is dialectical behavioral therapy 

ellie:

thanks 

Dr. Markovitz:

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. 

Patty

Diagnostic Statistic Manual 

Dr. Markovitz:

Diagnostics and statistics manual (DSM) has all psyche diagnoses. 

babybj: 

thanks patty and doc 

tearscorrode:

(Doctors use DSM guidelines to give illnesses a "name") 

Dr. Markovitz:

well put 

babybj: 

k 

ellie:

lance had a good question

lance37:

I rip all my scabs off my body and get sores without remembering how they got there is that the same as cutting 

Dr. Markovitz:

 yes, same as cutting. Does it feel good? 

lance37:

yes it feels great 

tearscorrode: 

that's what I thought... 

Dr. Markovitz:

Great article in June 5 US magazine about famous people that cut. 

Patty:

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? 

Dr. Markovitz:

No, but it could Patty. 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 

Patty:

thanks 

Dr. Markovitz:

Do not need to cut to have bpd. It is a symptom. One of many. 
You do not need vomiting to have flu. Some do, some do not 

Tim:

 Is cutting a good indicator of the BPD??

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