Q. I was diagnosed with borderline personality disorder and cyclothymic disorder some 13 years ago while in the military after a suicide attempt. Originally put on no medication with no follow-up, I have had a great struggle. I started receiving psychiatric care at a local VA medical center 2 years ago after being awarded a disability. After looking over the web page, I was surprised to see borderline personality disorder and bipolar disorder linked. The only medication I have ever taken is Paxil, and this has helped me quite a bit, but I suffer from break-through depression & manic episodes. Although symptoms are not as severe as they were before medication, I feel like I am developing a tolerance to the Paxil. Are there other medications that you think could help me? The MD I see at the VA says the Paxil is not intended to help the cyclothymia, only to alleviate symptoms of the depression I feel because of the cyclothymia and borderline personality disorder.


  A. I do not know enough to give you a specific opinion on yourself, but will give you some general data. There is a body of studies to support the use of serotonin reuptake inhibitors in bipolar type II. One study looked at Prozac, and another at Zoloft (none yet with Paxil that I know about, but it should work). In both cases, they definitely treated the depression, and did cause mania. One possibility is you need higher dosages of Paxil. Another is that you need something else, perhaps a drug like Topamax or Neurontin. Follow your doctor's advice, and try to give them the information they need to help you. Any type of a cycling illness is hard to treat, and it takes time.