Psycho-Babble Medication Thread 748239

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Are MAOIs more effective for most BPDers...

Posted by Colleen D. on April 8, 2007, at 21:08:28

than SSRIs + mood stabilizers or stimulants? I see my new therapist on Friday (the 13th - yikes!) and I want to be well-armed with med info. I have not been dx'ed with Borderline PD, but I sure can relate to the behavior patterns of patients I'm reading about in "Lost in the Mirror" by Richard Moskovitz.

http://www.amazon.com/gp/reader/0878332669/ref=sib_dp_pt/103-7804163-8774249#reader-link

High dose Effexor pooped out on me over a year ago and I've not yet found the right combo of meds to get that energetic, pro-social feeling back. I'm taking Zoloft 100mg, Lyrica 200mg, and clonazepam 1mg daily. I occasionally use doxepin 25-50mg for sleep and nighttime anxiety.

Anyone have experience with BPD and several med trials?

Thanks lots!

Colleen

 

Re: Are MAOIs more effective for most BPDers... Colleen D.

Posted by Phillipa on April 8, 2007, at 21:34:17

In reply to Are MAOIs more effective for most BPDers..., posted by Colleen D. on April 8, 2007, at 21:08:28

I'd think a mood stabalizer would be one of the meds. Love Phillipa

 

Re: Are MAOIs more effective for most BPDers...

Posted by med_empowered on April 8, 2007, at 23:47:46

In reply to Are MAOIs more effective for most BPDers..., posted by Colleen D. on April 8, 2007, at 21:08:28

I think it has more to do with the depression "type," not so much Bipolar vs Unipolar. "Anergic" depression--similar to "atypical depression"--is common in bipolar, especially BP II. Wellbutrin, MAOIs, and selective stimulant use are all good options (alone or in some sort of combo) for this sort of depression. If you have BP II, you ***MIGHT*** be able to do OK with just an antidepressant. Supposedly, MAOIs have a lower "switch rate" than some other meds (like the tricyclics), but...any antidepressant can cause switching or straight-up med-induced mania/psychosis, so its always an issue.

Have you tried Provigil?

 

Re: Are MAOIs more effective for most BPDers... med_empowered

Posted by greywolf on April 9, 2007, at 8:30:01

In reply to Re: Are MAOIs more effective for most BPDers..., posted by med_empowered on April 8, 2007, at 23:47:46


I think Colleen is referring to borderline personality disorder, not bipolar.

Greywolf

 

Re: Are MAOIs more effective for most BPDers... Colleen D.

Posted by Jedi on April 9, 2007, at 8:58:14

In reply to Are MAOIs more effective for most BPDers..., posted by Colleen D. on April 8, 2007, at 21:08:28

Hi Colleen,
I don't have BPD, but it seems from my reading that the atypical antipsychotics are being used a lot for this disorder. The dosages seem to be quite high in some of the studies. Seroquel dosages were 400 to 800mg in one study. I use Seroquel for insomnia induced by Parnate and 25 to 50mg knocks me out like a light.
Good Luck,
Jedi


Pharmacopsychiatry. 2005 Jan;38(1):20-3.
Emerging evidence for the use of atypical antipsychotics in borderline personality disorder.
Grootens KP, Verkes RJ.
UMC St Radboud Nijmegen, Unit for Clinical Psychopharmacology and Neuropsychiatry, 6500 HB Nijmegen, The Netherlands. k.grootens@psy.umcn.nl

BACKGROUND: The availability of new atypical antipsychotics provides new opportunities for the treatment of borderline personality disorder (BPD). METHODS: Original papers on this topic were sought. Our study reviewed and discussed 14 papers. RESULTS: 2 RCTs, 4 non-controlled open-label studies and 8 case reports. The patient populations studied were highly diverse and the dropout rate after a long follow-up period was high. All of the articles reported positive effects of olanzapine, clozapine, quetiapine and risperidone. CONCLUSION: BPD patients with psychotic-like, impulsive or suicidal symptoms might benefit from atypical antipsychotics. Since the methodological quality of the reviewed articles is poor, further randomised placebo-controlled studies with longer follow-ups are needed before any firm conclusions can be drawn.

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Prog Neuropsychopharmacol Biol Psychiatry. 2007 Jan 30;31(1):158-63. Epub 2006 Oct 11.
Quetiapine for the treatment of borderline personality disorder; an open-label study.
Perrella C, Carrus D, Costa E, Schifano F.
I Clinica Psichiatrica, Policlinico Umberto I, Universita La Sapienza di Roma, Viale Dell'Universita, 30 - 00185, Rome, Italy.

PURPOSE: Only a few studies have commented on the use of atypical antipsychotics for the treatment of Borderline Personality Disorder (BPD) features, including affective dysregulation and aggression. We aimed at evaluating both efficacy and safety of quetiapine in a sample of consecutive BPD patients. GENERAL METHODS: 29 BPD outpatients entered, and 23 completed, a 12 week, open-label, regime of quetiapine at an average daily dosage of 540 mg (range: 400-800 mg). Efficacy assessment psychometric instruments included: Hamilton Rating Scales for Depression (HAM-D); Brief Psychiatric Rating Scale (BPRS); Global Assessment of Functioning (GAF); Clinical Global Impression Scale (CGI); and Aggression Questionnaire (AQ). FINDINGS: Both completer and intent-to-treat analysis showed that most psychometric scales' scores exhibited a highly significant (HAM-D: p=.003; BPRS Hostility and Suspiciousness subscales; CGI; GAF; AQ: all at p=.000) improvement over time. Six patients dropped out early from treatment due to side effects; quetiapine was associated with two cases of transient thrombocytopenia. CONCLUSIONS: Present findings would suggest that quetiapine may be effective for the treatment of a number of BPD features, including low mood and aggression. However, monitoring blood counts in patients receiving quetiapine seems to be justified.

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Psychopharmacology (Berl). 2007 May;191(4):1023-6. Epub 2007 Feb 23.
Aripiprazole in treatment of borderline patients, part II: an 18-month follow-up.
Nickel MK, Loew TH, Gil FP.
Clinic for Psychosomatic Medicine and Psychotherapy, Medical University of Graz, 8990, Bad Aussee, Austria.

RATIONALE: Only one controlled trial is known that employed aripiprazole for patients with borderline personality disorder (BPD). This 8-week trial found significant changes on most scales of the symptom checklist (SCL-90-R), Hamilton depression rating scale (HDRS), Hamilton anxiety rating scale (HARS), and on all scales of the state-trait anger expression inventory (STAXI). OBJECTIVES, MATERIALS, AND METHODS: To assess the long-term effectiveness of aripiprazole with multifaceted borderline symptomology, this 18-month follow-up observation with biannual testing was carried out with the same patients from the previous trial (treated with 15-mg aripiprazole daily, n = 26, 21 female and 5 male patients; previous placebo group, n = 26, 22 female and 4 male patients). RESULTS: According to the intent-to-treat principle, significant changes on all scales of the SCL-90-R, HDRS, HARS, and STAXI were observed in the aripiprazole-treated subjects after 18 months. CONCLUSION: Aripiprazole appears to be an effective and relatively safe agent in the long-term treatment of patients with BPD.
_______________________________________________________________

> than SSRIs + mood stabilizers or stimulants? I see my new therapist on Friday (the 13th - yikes!) and I want to be well-armed with med info. I have not been dx'ed with Borderline PD, but I sure can relate to the behavior patterns of patients I'm reading about in "Lost in the Mirror" by Richard Moskovitz.
>
> http://www.amazon.com/gp/reader/0878332669/ref=sib_dp_pt/103-7804163-8774249#reader-link
>
> High dose Effexor pooped out on me over a year ago and I've not yet found the right combo of meds to get that energetic, pro-social feeling back. I'm taking Zoloft 100mg, Lyrica 200mg, and clonazepam 1mg daily. I occasionally use doxepin 25-50mg for sleep and nighttime anxiety.
>
> Anyone have experience with BPD and several med trials?
>
> Thanks lots!
>
> Colleen


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