Borderline Personality Disorder Chat Conference:

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

Page Four

Snowonthemountain:

but doctor I am afraid if I go back in they will keep me for months- it was supposed to have been 3-4 months the first time 

Drewbug:

don't even know if there is any hospital around here other than state... 

Entre2chaises:

Some of the people at that hospital were from out of state. 

Dr. Markovitz: 

The world is not perfect, anast. One bad experience does not make the whole system bad. 

Anast:

OK DR M, as a diabetic, if I overeat, on a constant basis is that considered SI? 

Tim:

and with insurance the way it is they keep people as less they can 

Anast:

DR M, no one knows that more than I 

Entre2chaises:

anast, it is in my book 

Gillian:

SI? 

Anast:

BOOK, what book? 

Entre2chaises:

SI = self injury 
anast, it's an expression 

Dr. Markovitz: 

Depends, anast. If you are on Zyprexa or Remeron, you will have no biological choice. If you deliberately/volitionally do it, it is not healthy behavior at a minimum. 

Ellie:

I think over-eating in a different problem from self-harm 

Freaked:

I’m a big over eater <anast> I have been purposefully eating excess sugar 

Entre2chaises:

When I was overeating, I knew I was harming myself. I knew it would kill me eventually. 

Drewbug:

anast... sounds like you answered your own question 

Dr. Markovitz: 

Sugar is a way to get tryptophan into the brain to make serotonin. Maybe you need more, different or better meds. 

Anast:

I know! 

Entre2chaises:

I think the excess sugar crave is a kind of self-medication, only it makes it all worse. At least, that is how it is for me. 

Twisted:

hmmm.. will it ever go away?????????? 

Patty:

Dr. is it true that BPDs normally have large carbohydrate cravings? If so, why? 

Ellie:

Patty, I sure do! 

Dr. Markovitz: 

Lady named Wurtman at MIT did a ton of work on sugar eating and how it effects body. May want to look up her books 

Bingle:

will meds to increase dopamine also increase serotonin? 

Dr. Markovitz: 

depends on the med bingle 

Anast:

I am taking 300,mg Effexor, 150 wellbutrin and just got put on Neurontin 600mg 

Opalene:

I wish there was a way that we could all get our hormones scrutinized I am sure we will all have something unusual in common 

Dr. Markovitz: 

anast, have you been on 450 or more of Effexor? 

Entre2chaises:

I found tremendous relief from many BPD symptoms when I became a strict vegetarian. 

Ellie:

that's interesting entre 

Drewbug:

fyi... there's a new book out called the anti-depressant survival book (or really close) that looks fairly useful... or might be if I had more willpower ;) 

Dr. Markovitz: 

there is some data to suggest reducing carbohydrates may help some with bpd 

Anast:

no doc, my doc wouldn’t do it, he put me on the Neurontin instead <bingle1> what meds would increase serotonin? 

Entre2chaises:

I typically avoid sugar & caffeine very successfully, but the other day I had a little binge of sugar and caffeine. 

Bingle:

I already take wellbutrin but I also really crave sugar much more than I ever have 

Dr. Markovitz: 

anast, have him read my BPD paper in Psychopharmacology Bulletin. 450 of Effexor alone will do it for you 

Entre2chaises:

I then went on an online shopping binge... ugh. 

Patty:

I know that imipramine causes sugar cravings in some. 

Drewbug:

entre... know that feeling :/ 

Anast:

he told me that you don’t treat bpd, you treat the sx <DrM> entre, you may have eaten sugar because an episode was coming on. Like having nausea before you vomit, and the binge shopping was the continuation of the cycle. Not cause of the sugar 

Entre2chaises:

FWIW, there's a big difference between refined carbs and those in whole foods. 

Anast:

so I am taking all these drugs for nothing? 

Entre2chaises:

I do not recommend high-protein diets at all. 

Dr. Markovitz: 

if the drugs help, its great. If not, try something else 

Gillian:

Dr, I want to get back to work doing nursing as soon as possible, but the medications make me sleepy and forgetful 

Dr. Markovitz: 

There was no effective treatment for BPD of note prior to Prozac 

Gillian:

Are they some that would not 

Entre2chaises:

Thanks, DrM. I thought there may have been a connection. 

Gillian:

*some 

Drewbug:

how do I know if they're helping> what if I could feel better and I just don't know it? 

Anast:

Gillian that is a constant state for me lol 

Crazyme:

Dr. how can we get our mind to stop thinking either we are good or bad, like one day I am really in a good mood then the next day I can be suicidal...just depends on my thought for the moment or day. I flip back and forth all the times sometimes with in the same day 

Dr. Markovitz: 

Gillian, the Provigil (modafinil) may help you a ton 

Drewbug:

I would give anything to have my mind just *shut* *up* 

Entre2chaises:

Gillian- ditto anast 

Dr. Markovitz: 

CrazyMe, that is where the therapy helps. 

ForestLobo:

drewbug-know exactly what you mean 

Ellie:

Dr M, what do you think of Celexa for treating depression and bpd? I am on 20mg. 

Jbtawny:

didn't have time; no abuse from here though. 

Drewbug:

ellie... I’m on Celexa too... thanks for the question :) 

Dr. Markovitz: 

ellie, it s okay, but most folks need 60-120 mg/day to work 

Ellie:

really? oh. 

Entre2chaises:

Celexa didn't work for me. 

Crazyme:

I have been in therapy for 3 years and not sure if it helps but afraid to leave her cause I like talking to her and she has helped thru some rough times 

Dr. Markovitz: 

all the SSRI's (Prozac, Zoloft, Luvox, Paxil, and Celexa ) are pretty much the same 

Drewbug:

wow... 4 out of 5 on that list, just within the last 3 years 

Snowonthemountain:

kids needed me! 

ForestLobo:

Therapy, writing, meds, sleep if all else fails 

Anast:

Doc did you answer my ? about where I can find you paper? 

Entre2chaises:

gillian, my vegan diet has helped me a LOT with my energy level. 

Crazyme:

thanks ellie you always understand me, so I don't feel so alone 

Drewbug:

forest... yeah... I sleep a lot :/ 

Ellie:

aw. you're welcome! (((crazyme))) 

Freaked:

I’m going to need to go on meds.... I have no idea what I need <DrM> Any medical library will have a copy in Psychopharm Bulletin. 

ForestLobo:

It is that or permanent oblivion drew 

Gillian:

I eat no red meat just chicken and fish 

Tim: 

Anast, you'd find the paper at a medical library 

Drewbug:

freaked... it's okay... that's what the doctors are for 

Freaked:

what happens if I get a screwy pdoc 

Opalene:

Dr. M do you know any research that I can follow concerning BPD's ramifications on the body? 

Twisted:

DrM.. medicine doesn’t seem to make the difference from what I can see, why do doctors keep prescribing <drewbug> freaked... then you go to someone else 

Ellie:

Freaked, just tell the doc all your current symptoms/problems 

Dr. Markovitz: 

No data I know about concerning BPD's ramifications on the body 

Freaked:

lol that would take forever 

Jbtawny:

I've found medication very helpful but I guess you have to find what works for you... 

Ellie:

;) freaked, write them all down. 

Entre2chaises:

twisted, meds have made all the difference for me... once we found the right one. 

Tim:

I think medication for most mental illness is trial and error 

Gillian:

Dr. Markovitz, do you see bpd more in any ethnic group more than others? 

Snowonthemountain:

my t told me that I was working too hard to overcome the bpd- Dr. M. do you think that is possible? 

Dr. Markovitz: 

It is not easy getting the meds balanced. 
No, you cannot work too hard to overcome BPD. 

Drewbug:

Dr. M. ... how do you know when to just give in and decide "okay, this is as good as I’m going to feel on meds"... or are you supposed to just keep trying? 

Snowonthemountain:

Can you become too focused on the bpd recovery - is that what he might have meant? 

Dr. Markovitz: 

One of the reasons they call people bipolars or depressives when hospitalized is the hospital is not paid if they call you BPD! 

Ellie:

woah. that is so wrong 

Entre2chaises:

drew, good question 

Jbtawny:

my therapist said that bpd is over diagnosed; should I question my diagnosis? 

Dr. Markovitz: 

You have to focus realistically on recovery. Not obsessively 

Dr. Markovitz: 

ib, if you have the symptoms, it probably is BPD. 

Entre2chaises:

This is really interesting, but I have to go. Thanks for being so kind to me during my visit.