Posted by Dinah on January 25, 2002, at 9:15:27
In reply to Re: Soft Bipolar Disorders, posted by petters on January 25, 2002, at 7:12:27
>
> Hi Blue...
>
> You are correct. Like OCD, one often need high dosages for BPD. The affective instability that is characteristic for this people often improve very well on high dosages ssri or venlafaxine.
>
> Sincerely...//PettersI have mixed feelings about this topic. People with OCD and BPD are in a lot of pain and do need help. High does of SSRI's flatten moods, increase apathy, and reduce cognitive function (especially memory). So of course high doses of SSRI's work for BPD. By making you numb emotionally and apathetic, many of the behaviors will disappear. Those around you are happier because you are behaving better. The same holds true for OCD. SSRI's cause apathy and reduce your ability to remember what you might have done to cause disaster. So naturally the symptoms are less too and you aren't so much trouble to those around you.
But what is the cost? Extremely high doses of SSRI's rob you of your motivation and to a certain extent your humanity. (I'm talking about extremely high doses here, so don't flame me over this.) I was on Luvox at up to 300mg for four years, and I'm not sure I've fully recovered yet my ability to love and laugh and feel fully engaged in life.
Wouldn't it be worth the additional time and expense to combine lower doses of SSRI's with really good therapy programs like Linehan's DBT or CBT and then follow-up long term supportive therapy? I know health care dollars are short, but for those who have the money and the motivation to change, I would think that this would be first line treatment for both OCD and BPD. Both disorders have shown themselves extremely well suited to these therapies.
Of course, not everyone has the motivation to change, and everyone is different and have different degrees of these disorders, but I have to agree with Elizabeth here. Treatment should be more personalized to the individual. And I also agree with her that BPD is an umbrella diagnosis that probably covers a lot of different underlying problems. Just because high dose SSRI's routinely work with BPD doesn't change that fact.
Just my opinion based on my personal experience, put out mainly for the purpose of discussion.
Dinah
poster:Dinah
thread:91182
URL: http://www.dr-bob.org/babble/20020124/msgs/91534.html