What You Need to Know About Borderline Personality Disorder - Part l

Your life isn't working right. You have a lot to feel depressed or agitated about. You see a general practitioner or psychiatrist, who prescribes an antidepressant for your depression. An antidepressant tends to be the default first option for those who tend to feel out of sorts.

But what if the antidepressant doesn't work?

In the event of one failed or partially successful trial on an antidepressant, the American Psychiatric Association in its 2000 Practice Guideline for treating depression recommends a trial on a second antidepressant or augmenting the first antidepressant with another medication. In 2006, an NIMH-underwritten series of real world clinical trials -STAR*D - came up with the data to validate the APA. In STAR*D, a quarter of the patients who failed on their first antidepressant got completely better (not just responded) to a different antidepressant or to another med added to their first.

But what if your second antidepressant fails? The APA recommends yet more antidepressant/augmenter options, but STAR*D findings indicate that the APA strongly needs to rethink its position. According to STAR*D:

"Study results suggest that switching antidepressants … after two consecutive antidepressant medication trials have failed provides only a modest chance of producing remission in major depressive disorder."

Perhaps it's time to reconsider the diagnosis. Unfortunately, this is not spelled out as an option by the APA, and STAR*D makes no reference to this. The APA and STAR*D make the assumption that psychiatrists are infallible at nailing the correct diagnosis on the first try, and that is a big mistake.

Most of us know better, often from bitter experience.

In my case, I was misdiagnosed with unipolar depression and put on an antidepressant. Like so many others, I flipped into mania. Diagnosing me with bipolar then became a no-brainer. I was one of the lucky ones.

Others aren't as fortunate. The antidepressant doesn't flip them into mania. It may make them feel a bit better. Or better but agitated. Or agitated. Or a hell of a lot worse. So the doctor simply recommends a second antidepressant, then a third. Then a fourth. In frustration, the doctor may start blaming the patient.

Various studies have confirmed that doctors often get our diagnosis wrong and that it may take them years to get it right, even when the obvious treatments don't work.

Finally, one day the doctor gets smart. More likely, a Lamictal drug rep has been to his or her office. So, even though you have no history of dancing on tables, the doctor is prepared to consider a bipolar diagnosis and prescribe a mood stabilizer.

For many of us, this is the beginning of our recovery. This was certainly the case with me. Once I was diagnosed with bipolar, suddenly my whole life began to make sense. The mood stabilizer I was prescribed slowed down my racing thoughts and reined in my impulses to the point that I was able to start rebuilding my life. Maybe this has happened to you.

So, obviously, psychiatrists need to have some kind of sign taped to their walls: