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I hope this is the proper forum, if not please feel free to move it. 

I'm concerned I'm making a bad decision concerning my health.

Last August I was diagnosed with OCD, GAD, Panic Disorder and Pain Disorder and a few months after that I was also diagnosed BPD.  In that time the only med I have taken has been Ativan and now Klonopin.

I have been refusing any other medicinal help because I am deathly afraid of the other meds they are recommending.  I have responded really poorly in the past to SSRIs and the only other recommendation I'm getting is atypical anti-psychotics which I don't want to touch with a 10-foot poll.  I have been told by both my psychiatrist and my psychologist that there is a good chance I will improve with just CBT therapy alone, but that I might improve faster with the meds.  I disagree because I know how much I will freak out about side effects, cost etc.

Adding to the problem is that I have an ED and a major hang-up about body image and stuff like that so I refuse any medication that might cause weight gain.  I gained over 50lbs on Paxil and the ED was what helped me finally lose it.  I'm not eating (more or less) normally again but my weight is still constantly on my mind.  I also just got engaged and have picked out a wedding dress and everything so I can't afford to balloon up or my dress might not fit me.

I'm not trying to be difficult or uncooperative, I just know that in many cases of BPD medications aren't very helpful.  The CBT therapy was incredibly useful but I had to abruptly stop because my insurance ran out and now I'm back in it again and my doctors are petitioning my insurance company to pay for a few extra sessions.

I would love some opinions here as to whether or not people think I'm completely nuts for being unwilling to go the drug route and whether they think a person is capable of getting better (or at least better enough to function a normal existence) through therapy alone.

Thanks,

Kelly

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you have a couple of conditions going on... not all of which therapy may be enough for.

you say you have issues with panic, ocd and pain. There are more med options out there than just SSRIs and APs.  Some ideas of meds/issues to talk to your doctor about are:  Cymbalta is known for helping with pain, and helps some with anxiety.  Lyrica, an AC, was just approved in the US for neuropathic pain, and in the EU for anxiety.  Some people also find Neurontin helps with pain and anxiety.  Not all of the SSRIs cause weight gain, same with the APs.

i do beleive that BPD can be adressed with therapy alone.  but medication can make therapy easier and more effective.  i was once BPD, and after a year of intensive DBT and transference focused therapy, i am no longer borderline. 

it is true that no one medication has a stellar sucess rate curing bpd, but a lot of them really help the therapy process.  (my tdoc was fond of zyprexa, which i refused, but there are other AAPs out there that don't cause as much gain as zyprexa.)

as a side note, benzos are generally not thought to be good medications for BPD because they increase inhibition, and can lead to higher level of impulsive behavior.

also, you do have more than BPD going on.  while i know that i was able to overcome my BPD in therapy, i still have anxiety issues, ADD and MDD... all of which i am on medication for.

i think it's wonderful that you are fighting for this therapy, and i hope it works for you as well as DBT did for me

i just think that you should keep an open mind about medications. 

talk to your doctor honestly about your concerns, there are more options out there than just SSRIs and AAPs, and like i said, not all SSRIs and AAPs are that bad.

therapy is an amazing tool, but if medication can get you better faster, i, personally, would fight the battle with every available weapon.

good luck,

penny

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Heya Kelly,

I see where you're coming from about various psych meds and body image.

Absolutely get the best psychotherapy you can get.

Call GPPA and call CMHA.

Especially call GP Psychotherapy Association.  Family docs who do psychotherapy.  Covered by OHIP.  416-410-6644.

We talked about this before, you and me, but not this issue.

Therapy is best for mild to moderate psych probs.  Best in combination with drugs for severe probs.

So no!  Not nuts to want just therapy.  But realize that some people need therapy, meds, or *both.*  Most of us I think benefit from *both.*

Has your psych talked with you about the "typical" antipsychotics?  They address the manic-like symptoms of BPD, with less weight gain (although more extrapyramidal effects).

And.

What about mood stabilizers?  Some evidence they help in BPD.  And, some (like Lamictal) don't have weight-gain as a side effect.

And.

Think about your own motivation.

Okay.  Assuming the best medication for you is Risperdal.  (Not that it is, just an easy for-instance.)

So, your appetite goes up and your metabolism goes down.

So, you have to eat better food and more olive oil and more ... lentils ... celery.

If that's something you can do?

Take the meds.  Do the therapy.  Change your diet.

You can.

--ncc--

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