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Suggest Effective Treatment Of Bipolar Disorder
Question: I'm almost 63 and was just told that I have BPD, will
that be harder to treat at my age?
that be harder to treat at my age?
Brief Answer:
Can be effectively treated, observing precautions
Detailed Answer:
Hi,
I read your query and can understand your concern regarding effective treatment of Bipolar disorder at your age.I will try to put some facts before you which might answer your question.
Nearly 10% of cases of Bipolar disorder is diagnosed after the age of 50. It can be treated as effectively as in younger age. But certain precautions might have to be observed. In older age, there are higher chances of comorbid physical disorders for which treatment has to be continued. It is important to take care of any interaction of medicines used for bipolar disorder with other drugs. For example, you are on dyazide (combination of triamterene and hydrochlorothaizide, which are diuretics). One of the effective mood stabilizers, lithium can be affected by dyazide (dyazide can increase levels of lithium).
Another important thing is that one has to start with lower dosage of the drugs and increase it very gradually to reduce the chances of any side effects.
Currently you are on Lamotrigine. if your condition is stable on the drugs you have mentioned, you need not worry. Your psychiatrist will be the best person to decide regarding the type of the drug and its dosage. You are on three sedatives (lorazepam, clonazepam and ambien). I would suggest you talk to your psychiatrist, if they can be reduced. As a psychiatrist, I would like to keep my patients on minimum possible sedatives, especially in old age.
With proper treatment, your management can be done as effectively done as in younger people. Hope I have been able to answer your query. In case you have any further clarifications, feel free to ask.
Wishing you good health,
Dr. Sunil Gupta
Can be effectively treated, observing precautions
Detailed Answer:
Hi,
I read your query and can understand your concern regarding effective treatment of Bipolar disorder at your age.I will try to put some facts before you which might answer your question.
Nearly 10% of cases of Bipolar disorder is diagnosed after the age of 50. It can be treated as effectively as in younger age. But certain precautions might have to be observed. In older age, there are higher chances of comorbid physical disorders for which treatment has to be continued. It is important to take care of any interaction of medicines used for bipolar disorder with other drugs. For example, you are on dyazide (combination of triamterene and hydrochlorothaizide, which are diuretics). One of the effective mood stabilizers, lithium can be affected by dyazide (dyazide can increase levels of lithium).
Another important thing is that one has to start with lower dosage of the drugs and increase it very gradually to reduce the chances of any side effects.
Currently you are on Lamotrigine. if your condition is stable on the drugs you have mentioned, you need not worry. Your psychiatrist will be the best person to decide regarding the type of the drug and its dosage. You are on three sedatives (lorazepam, clonazepam and ambien). I would suggest you talk to your psychiatrist, if they can be reduced. As a psychiatrist, I would like to keep my patients on minimum possible sedatives, especially in old age.
With proper treatment, your management can be done as effectively done as in younger people. Hope I have been able to answer your query. In case you have any further clarifications, feel free to ask.
Wishing you good health,
Dr. Sunil Gupta
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Thank you for your response. However I believe you may have misunderstood or I should have spelled the issue out. It's not Bi-Polar I was asking about. It's Borderline Personality Disorder. Can you respond for that issue, please?
Kind regards,
Kind regards,
Brief Answer:
Yes its difficult but definitely possible
Detailed Answer:
Hi XXXXXXX
Thanks for following up and my sincere apologies for assuming that BPD meant bipolar disorder. One of the reasons for my grave error might be that generally borderline personality is diagnosed at a much earlier age.
As a psychiatrist, I would be curious to know the symptoms on the basis of which you were diagnosed borderline personality. It might be that you always had the symptoms, but it was picked up this late.
Borderline personality is a disorder or pervasive maladaptive patterns in personality characterized by unstable mood, impulsivity, suicidal behavior, chronic feeling of emptiness.
Treatment of borderline personality is usually non-pharmacological. And yes, it is definitely a bit more difficult to treat it at your age. The best treatment available is dialectical behavior therapy. But it is just a bit more difficult and not impossible. You should definitely give it a try.
Medicines are usually given to control associated mood disturbances or anxiety. I would again repeat what I said earlier regarding the sedatives. You can discuss the same with your psychiatrist.
Hope I have been able to answer your query. In case you have any further clarifications, feel free to ask.
Wishing you good health,
Dr. Sunil Gupta
Yes its difficult but definitely possible
Detailed Answer:
Hi XXXXXXX
Thanks for following up and my sincere apologies for assuming that BPD meant bipolar disorder. One of the reasons for my grave error might be that generally borderline personality is diagnosed at a much earlier age.
As a psychiatrist, I would be curious to know the symptoms on the basis of which you were diagnosed borderline personality. It might be that you always had the symptoms, but it was picked up this late.
Borderline personality is a disorder or pervasive maladaptive patterns in personality characterized by unstable mood, impulsivity, suicidal behavior, chronic feeling of emptiness.
Treatment of borderline personality is usually non-pharmacological. And yes, it is definitely a bit more difficult to treat it at your age. The best treatment available is dialectical behavior therapy. But it is just a bit more difficult and not impossible. You should definitely give it a try.
Medicines are usually given to control associated mood disturbances or anxiety. I would again repeat what I said earlier regarding the sedatives. You can discuss the same with your psychiatrist.
Hope I have been able to answer your query. In case you have any further clarifications, feel free to ask.
Wishing you good health,
Dr. Sunil Gupta
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Thank you for such quick responses, so much appreciated. First, I haven't been officially diagnosed, my therapist that I've been seeing for the past two years, finally got my daughter to come in and speak with her, (she hasn't spoken to me in five years, got married without me, has had a baby, (my only grandchild), I've never seen and I feel she has completely abandoned me). After their hour session that is when my therapist came up with that diagnosis, although she isn't as knowledgeable and doesn't treat it, she is pretty positive about it.
I believe the worst of it manifested after my father died. I was always too scared of him and kept everything inside, afraid to say anything. Now I've found that I do have periods of anger sometimes over nothing. I'm critical, I want everything to be perfect and nothing ever is. I can't maintain friendships and don't know what I've don't to have alienated anyone.
It's difficult for me to change what is working when work has upgrades, and because of that I have been left out of conference calls for fear of what I may comment about. I've got notes all over my wall that say "watch what you write and what you say", because sometime's I come off as being too critical, and protest, I've been reprimanded previously about that issue.
The data entry isn't perfect by co-workers, the data that needs to be entered is provided, but my co-workers leave a lot of it out of the system just to get it done as quickly as possible. Then I find myself constantly correcting others work, as I come across it.
Just a couple more questions for you now, and when I receive your answers it may help me to understand what is what here, because of the details I've provided above, which is just a few.
!. Why is it called Borderline? Is there something that makes it less than and not more than?
2. I''m very resistant to change, how is treatment going to help, especially if I can't understand what Mind-fullness and Dialectical Behavior Therapy, is supposed to do?
I await your response and really do appreciate your precious time in responding to my comments.
Oh, the reason for the Ambien is because I'm very much an insomniac. And the other sedatives don't help me with sleep. (I have a very high tolerance to a lot of medications, a lot of times I don't even think they do anything for me.
Very kind regards,
XXXX
I believe the worst of it manifested after my father died. I was always too scared of him and kept everything inside, afraid to say anything. Now I've found that I do have periods of anger sometimes over nothing. I'm critical, I want everything to be perfect and nothing ever is. I can't maintain friendships and don't know what I've don't to have alienated anyone.
It's difficult for me to change what is working when work has upgrades, and because of that I have been left out of conference calls for fear of what I may comment about. I've got notes all over my wall that say "watch what you write and what you say", because sometime's I come off as being too critical, and protest, I've been reprimanded previously about that issue.
The data entry isn't perfect by co-workers, the data that needs to be entered is provided, but my co-workers leave a lot of it out of the system just to get it done as quickly as possible. Then I find myself constantly correcting others work, as I come across it.
Just a couple more questions for you now, and when I receive your answers it may help me to understand what is what here, because of the details I've provided above, which is just a few.
!. Why is it called Borderline? Is there something that makes it less than and not more than?
2. I''m very resistant to change, how is treatment going to help, especially if I can't understand what Mind-fullness and Dialectical Behavior Therapy, is supposed to do?
I await your response and really do appreciate your precious time in responding to my comments.
Oh, the reason for the Ambien is because I'm very much an insomniac. And the other sedatives don't help me with sleep. (I have a very high tolerance to a lot of medications, a lot of times I don't even think they do anything for me.
Very kind regards,
XXXX
Brief Answer:
See details below
Detailed Answer:
Hi XXXXXXX
Thanks for following up and thanks for your kind appreciation. It is such words from people like you which helps us put extra effort to help those in need.
I went through your response and from what you have mentioned, I will try to answer your questions. As you have correctly mentioned that the details are few, and even more when face to face interview cannot be replaced with anything, I might not be exact at places.
You have mentioned that you are impulsive at times. More importantly, it is your desire to be perfect which is creating more trouble and which is causing you to be critical of others' work.
I would be interested in knowing if you are very punctual, worry a lot about cleanliness, keeping things in their right place and always try to follow rules and regulations. I am asking these, cause the points that you have mentioned are also suggestive of an anankastic personality, where a person in addition to perfectionism has the characters that I have asked.
Now, let me try to answer you direct questions. Borderline personality traits are a combinations of characteristics where a person is mostly emotionally unstable, feels empty, has unstable relationships, has dichotomous view of the world (anything is either good or bad, there are no shades of grey). Such a person is impulsive and has marked tendency for anger outbursts and self harm behavior.
The exact cause of developing such a personality or for that matter any personality is difficult to say. It is usually a combination of genetics, parenting, environmental influence. In your case, your fear of your father might have played some role in developing your personality, be it borderline or anakastic.
Let me try to be more clear. Every person has some kind of personality. Any person can be impulsive, or crave for perfectionism or be dependent or anxious. But that doesn't mean that the person has a personality disorder. To term it a personality disorder, there must be some personal distress associated or interpersonal relationship problems. In your case, whatever type of personality you are having, it is seemingly causing interpersonal relationship problems.
Coming to your second question. Your being resistant to change can also be because of your being anakastic. Anyway, we all undergo changes in our personality throughout our age, although we don't notice it much. Its just a matter of learning a new behavior. It is difficult but not impossible.
As for dialectical behavior therapy, I am not even sure as of now if it is the right therapy for you. First step will have to be a definitive diagnosis. If then if Dialectical behavior therapy is needed, you don't need to worry. none of the patients know much about it when they start. Its gradual learning process. Once the session will start, you will be educated about it and the process of change will be very slow.
So, for now, I will suggest seeking a consultation for detailed evaluation of your personality. Once that is done, further steps can be taken accordingly.
Hope I have answered your query. If you have any further clarifications, please feel free to ask. If you do not have any clarifications, you can close the discussion and rate the answer.
Wishing you best of great health.
Dr. Sunil Gupta
See details below
Detailed Answer:
Hi XXXXXXX
Thanks for following up and thanks for your kind appreciation. It is such words from people like you which helps us put extra effort to help those in need.
I went through your response and from what you have mentioned, I will try to answer your questions. As you have correctly mentioned that the details are few, and even more when face to face interview cannot be replaced with anything, I might not be exact at places.
You have mentioned that you are impulsive at times. More importantly, it is your desire to be perfect which is creating more trouble and which is causing you to be critical of others' work.
I would be interested in knowing if you are very punctual, worry a lot about cleanliness, keeping things in their right place and always try to follow rules and regulations. I am asking these, cause the points that you have mentioned are also suggestive of an anankastic personality, where a person in addition to perfectionism has the characters that I have asked.
Now, let me try to answer you direct questions. Borderline personality traits are a combinations of characteristics where a person is mostly emotionally unstable, feels empty, has unstable relationships, has dichotomous view of the world (anything is either good or bad, there are no shades of grey). Such a person is impulsive and has marked tendency for anger outbursts and self harm behavior.
The exact cause of developing such a personality or for that matter any personality is difficult to say. It is usually a combination of genetics, parenting, environmental influence. In your case, your fear of your father might have played some role in developing your personality, be it borderline or anakastic.
Let me try to be more clear. Every person has some kind of personality. Any person can be impulsive, or crave for perfectionism or be dependent or anxious. But that doesn't mean that the person has a personality disorder. To term it a personality disorder, there must be some personal distress associated or interpersonal relationship problems. In your case, whatever type of personality you are having, it is seemingly causing interpersonal relationship problems.
Coming to your second question. Your being resistant to change can also be because of your being anakastic. Anyway, we all undergo changes in our personality throughout our age, although we don't notice it much. Its just a matter of learning a new behavior. It is difficult but not impossible.
As for dialectical behavior therapy, I am not even sure as of now if it is the right therapy for you. First step will have to be a definitive diagnosis. If then if Dialectical behavior therapy is needed, you don't need to worry. none of the patients know much about it when they start. Its gradual learning process. Once the session will start, you will be educated about it and the process of change will be very slow.
So, for now, I will suggest seeking a consultation for detailed evaluation of your personality. Once that is done, further steps can be taken accordingly.
Hope I have answered your query. If you have any further clarifications, please feel free to ask. If you do not have any clarifications, you can close the discussion and rate the answer.
Wishing you best of great health.
Dr. Sunil Gupta
Above answer was peer-reviewed by :
Dr. Yogesh D
Again, I really do appreciate you for letting me take up so much of your time, answering my questions. I do have an appointment scheduled for XXXXXXX 5, with the Psychiatric P.A that has been seeing me every 12 weeks she monitors my medications, and chit chat for a bit over really not much. This has been going on for over the past two years. We do know that I have minor OCD and major depression, there has been no mention of Borderline Personality Disorder. Also I've only actually seen the Psychiatrist once in all that time.
In response to your query: "I would be interested in knowing if you are very punctual, worry a lot about cleanliness, keeping things in their right place and always try to follow rules and regulations. I am asking these, cause the points that you have mentioned are also suggestive of an anankastic personality, where a person in addition to perfectionism has the characters that I have asked." ...
Yes I am very punctual, I'd rather be an hour early than even 1 minute late. I have always followed all rules and regulations since grade school. I used to worry about a lot about cleanliness, however, since I am an empty nester, I don't worry so much about the dust and vacuuming, (too painful on my lower back, have had a spinal fusion after suffering for over twenty years). However the kitchen and bathrooms are always clean and my bed is always made first thing in the morning.
Let's just say, to give you an idea about my father: At the age of 3, he broke my nose, I think that should give you an idea of why I was so fearful of him. Plus my mother had MS and was unable to do anything for herself, (her MS was very aggressive and she died ten years after getting diagnosed, I do remember the last time I saw her walk I was only 5) and at that age I became her caretaker, now that is a whole other story I won't even begin to go through. He would come home from work and be so angry over something and I'd see him beat her when she couldn't even protect herself. I thing that sums up a bit of how I was raised.
You have been so kind for all your responses.
With sincere gratitude,
XXXX
In response to your query: "I would be interested in knowing if you are very punctual, worry a lot about cleanliness, keeping things in their right place and always try to follow rules and regulations. I am asking these, cause the points that you have mentioned are also suggestive of an anankastic personality, where a person in addition to perfectionism has the characters that I have asked." ...
Yes I am very punctual, I'd rather be an hour early than even 1 minute late. I have always followed all rules and regulations since grade school. I used to worry about a lot about cleanliness, however, since I am an empty nester, I don't worry so much about the dust and vacuuming, (too painful on my lower back, have had a spinal fusion after suffering for over twenty years). However the kitchen and bathrooms are always clean and my bed is always made first thing in the morning.
Let's just say, to give you an idea about my father: At the age of 3, he broke my nose, I think that should give you an idea of why I was so fearful of him. Plus my mother had MS and was unable to do anything for herself, (her MS was very aggressive and she died ten years after getting diagnosed, I do remember the last time I saw her walk I was only 5) and at that age I became her caretaker, now that is a whole other story I won't even begin to go through. He would come home from work and be so angry over something and I'd see him beat her when she couldn't even protect herself. I thing that sums up a bit of how I was raised.
You have been so kind for all your responses.
With sincere gratitude,
XXXX
Brief Answer:
Please see a psychiatrist
Detailed Answer:
Dear XXXXXXX
Thanks for your kind appreciation. You can stop thinking that you are taking up my time. I think that is why I decided to become a psychiatrist; to help people like you. You are just giving me an opportunity to do my job.
Having read your response, I am now pretty sure that you have anankastic traits in your personality. Your being disciplined, punctual, critical of others' work are very suggestive of that. I think that is why many people would even be thinking of you as rigid and resistant to change.
I was deeply moved to learn about your childhood. I am really sorry to hear about your mother and the way your father treated both you and your mother. Childhood experiences play a major role in determining adult personality. Your parenting have definitely played a part here.
Currently, I would suggest that you seek an appointment with your psychiatrist and discuss the issues regarding your personality with him in detail. Accordingly, you can take a decision regarding what to do or not to do ahead.
On a personal level, you can also try to mend some bridges. To start with, you can try to re-initiate contact with your daughter. Just try to talk to her and try to find out why did she decide to stop having any contact with you. May be with effort, you can bond again with her. That will definitely help you feel better.
Hope I have been able to help you. Please feel free to follow up with any query that you may have further. I will try my best to answer and help in the best possible way.
Best wishes,
Dr. Sunil Gupta
Please see a psychiatrist
Detailed Answer:
Dear XXXXXXX
Thanks for your kind appreciation. You can stop thinking that you are taking up my time. I think that is why I decided to become a psychiatrist; to help people like you. You are just giving me an opportunity to do my job.
Having read your response, I am now pretty sure that you have anankastic traits in your personality. Your being disciplined, punctual, critical of others' work are very suggestive of that. I think that is why many people would even be thinking of you as rigid and resistant to change.
I was deeply moved to learn about your childhood. I am really sorry to hear about your mother and the way your father treated both you and your mother. Childhood experiences play a major role in determining adult personality. Your parenting have definitely played a part here.
Currently, I would suggest that you seek an appointment with your psychiatrist and discuss the issues regarding your personality with him in detail. Accordingly, you can take a decision regarding what to do or not to do ahead.
On a personal level, you can also try to mend some bridges. To start with, you can try to re-initiate contact with your daughter. Just try to talk to her and try to find out why did she decide to stop having any contact with you. May be with effort, you can bond again with her. That will definitely help you feel better.
Hope I have been able to help you. Please feel free to follow up with any query that you may have further. I will try my best to answer and help in the best possible way.
Best wishes,
Dr. Sunil Gupta
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank you Dr. XXXXXXX as far as mending bridges with my daughter this has been the whole basis of going into therapy and just getting told by my therapist last week that she strongly believed that I have Borderline Personalty Disorder. That was after she finally got my daughter to come in and discuss why she won't speak to me and the reasons why she has abandoned me. There are a lot of emotions that I'm feeling as well as all the others issues mentioned above. Basically, I'm a long way off getting the bridge to my daughter mended, if at all. Even getting her on the phone would be a miracle. She is one stubborn girl. When she was 6 weeks old I knew then that I was in trouble, her stubbornest was already showing itself. At 8 weeks she was in the pool, at 7 months she was walking and it was non stop from there. I had to raise her alone starting around the age of four (I caught her father cheating and kicked him out, (once a cheater always a cheater) we had been married almost eight years). He didn't bother to take the time to be in her life after that, to which she blames me for. To top it all off, she was an honor student from kindergarten through college. I was always praising her on how well she was doing, I never said anything negative to her if she got a B instead of an A on something and of course that was the only B she got. After graduation she told me that when I praised her I put too much pressure on her. I know I was way too lenient with her, I just didn't want to repeat what I suffered through. I could have been more of a disciplinarian, but was afraid to start, out of fear. I'd try to ground her and send her to her room, that would last maybe half the day instead of the week she was grounded for.
You've been such a kind listener and it's been so easy talking about some of this in writing rather than face to face, I thank you for that.
You did get a laugh out of me with your brief answer above where you said to see a Psychiatrist. I know you were serious, but it did make me laugh. My appointment is XXXXXXX 5th.
So very grateful,
XXXX
You've been such a kind listener and it's been so easy talking about some of this in writing rather than face to face, I thank you for that.
You did get a laugh out of me with your brief answer above where you said to see a Psychiatrist. I know you were serious, but it did make me laugh. My appointment is XXXXXXX 5th.
So very grateful,
XXXX
Brief Answer:
Please see detailed reply below
Detailed Answer:
Dear XXXXXXX
Thanks for your kind words of encouragement. It is always nice to know that a person is feeling comfortable because of me and is able to open up. Also, it was good to know that you did laugh (unintentional from my side). Its always feels good if the next person is smiling or laughing and you know the reason is you (although I am a bit embarrassed here).
You have mentioned regarding the relationship between you and your daughter. I know you never meant to put any pressure over your daughter regarding her performance. But like your daughter has told you, somewhere unknowingly she felt the pressure. It might have been your constant encouragement to do better. It has done your daughter good which has reflected in her performance.
But if I try to look at things from her point of view, she would have felt that my mother is happier if I am doing well, which means I must continue doing well. Also, for any child, missing any of the parent (father or mother) while they are growing up is difficult. I know you have tried your best in making sure that your daughter gets the best but may be your daughter doesn't see things from your perspective.
You have seen a very tough life and I really feel the courage and strength inside you to have faced such adversities and keep on moving ahead. First having troubles with parents, then a husband who cheated on you and then having a daughter who doesn't want to have nay contact with you. But you have managed and will be able to do so even ahead. You just need to keep trying. You will have to be patient about your daughter, keep trying from your side and hope for the best. I believe that one day your daughter will be able to see the love within you for her and hopefully things will be brighter.
I do hope you will continue sharing your concerns ahead and I will look forward to reply to them honestly.
Best wishes,
Dr. Sunil Gupta
Please see detailed reply below
Detailed Answer:
Dear XXXXXXX
Thanks for your kind words of encouragement. It is always nice to know that a person is feeling comfortable because of me and is able to open up. Also, it was good to know that you did laugh (unintentional from my side). Its always feels good if the next person is smiling or laughing and you know the reason is you (although I am a bit embarrassed here).
You have mentioned regarding the relationship between you and your daughter. I know you never meant to put any pressure over your daughter regarding her performance. But like your daughter has told you, somewhere unknowingly she felt the pressure. It might have been your constant encouragement to do better. It has done your daughter good which has reflected in her performance.
But if I try to look at things from her point of view, she would have felt that my mother is happier if I am doing well, which means I must continue doing well. Also, for any child, missing any of the parent (father or mother) while they are growing up is difficult. I know you have tried your best in making sure that your daughter gets the best but may be your daughter doesn't see things from your perspective.
You have seen a very tough life and I really feel the courage and strength inside you to have faced such adversities and keep on moving ahead. First having troubles with parents, then a husband who cheated on you and then having a daughter who doesn't want to have nay contact with you. But you have managed and will be able to do so even ahead. You just need to keep trying. You will have to be patient about your daughter, keep trying from your side and hope for the best. I believe that one day your daughter will be able to see the love within you for her and hopefully things will be brighter.
I do hope you will continue sharing your concerns ahead and I will look forward to reply to them honestly.
Best wishes,
Dr. Sunil Gupta
Above answer was peer-reviewed by :
Dr. Prasad
Dr. XXXXXXX Thank y ou so much for all of your quick responses, helps to make me feel a little bit special, at least from my perspective.
I am going to try and get any and all the help I can get and I thank you for the encouragement to do so.
Kindly,
XXXX
I am going to try and get any and all the help I can get and I thank you for the encouragement to do so.
Kindly,
XXXX
Brief Answer:
Thank you.
Detailed Answer:
Dear XXXXXXX
Thank you for your feedback. Its the appreciation from people like you which motivates me to work on improving myself consistently and continuously in the field of Psychiatry.
In case of any future queries you can ask me directly on the following link:
http://doctor.healthcaremagic.com/doctors/dr-sunil-gupta/67657
It will be my privilege if I get a chance to help you at any point in future. You can now rate the answer and close the discussion.
Best wishes.
Dr. Sunil Gupta
Thank you.
Detailed Answer:
Dear XXXXXXX
Thank you for your feedback. Its the appreciation from people like you which motivates me to work on improving myself consistently and continuously in the field of Psychiatry.
In case of any future queries you can ask me directly on the following link:
http://doctor.healthcaremagic.com/doctors/dr-sunil-gupta/67657
It will be my privilege if I get a chance to help you at any point in future. You can now rate the answer and close the discussion.
Best wishes.
Dr. Sunil Gupta
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
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