Question:
Hello, I suppose this has been asked time and again and I haven’t seen the FAQ for this group … but trying to use Remarq’s web based thing is so time consuming that I hope I can have a question or two answered even if it’s been covered a million times. The main one is what, exactly, is the treatment for Borderline PD? Maybe I’ll just leave it at that for now. * Sent from RemarQ http://www.remarq.com The Internet’s Discussion Network * The fastest and easiest way to search and participate in Usenet – Free!
Response:
-=- kajira hill -=- wrote: > There is no *exact* treatment for BPD,
I see. > since the symptoms are many, > and not everyone has the same mix of symptoms.
Ah, so the DSM IV isn’t necessarily the end all and be all of this disorder? > Also, not everyone > starts out with the same chemical mix. Best would be a combination of > meds and therapy — but more specific than that I couldn’t begin to > say, since I’m not a professional. You’ll find that we are all on > different meds with varying results.
Sounds about the same course as for other psychiatric disorders. > It’s very unusual to get the > right med the first time, so don’t be disappointed when the > experimentation starts.
:-> Gottcha. Actually I was curious because of a recent experience. Long story short: Got a preliminary diagnosis of Borderline when I was 20 (I’m 30 now) and was immediately hospitalized because of the current state I was in. After 2 weeks the doctor(s) that saw me in the hospital ruled out Borderline (I guess, because actually no one ever told me about it and I only recently found out) and ruled in Bipolar. I was in a mixed episode. Back then it was pretty much just lithium used to treat that and lithium and I didn’t get along to well, so I was constantly on and off it (and various ADs) for years. I moved. Hadn’t had any type of psychiatric treatment since 1996. This spring (as is typical for me) I got into a mixed episode and this one was particularly bad. One of the worst I’ve had. I went to cmh here and was hospitalized. The doc in the hospital only got *some* of my old records, and consequently thought I was Borderline. I was treated what I perceived (and my therapist agreed) as *quite* badly because of this. It eventually came out that I was Bipolar and in a mixed state – and then everyone’s attitude and treatment of me changed dramatically. I can’t help but wonder if Borderline really were my primary Dx should I have been treated that way? I asked my therapist if that is the way to treat a person with Borderline and she said "I would hope not." > I’ve been on everything (well, before they > started making all those new ADs) possible, I swear (okay, so it’s an > exaggeration), and I’m still not sure it’s all done right. And it’s > taken me years to find the right therp, and THEN my insurance wouldn’t > cover seeing her.
So, do people with Borderline need to take meds always? With Bipolar, I can’t stop taking them anymore. Ever. At least they’ve improved from the old days of lithium. What types of therapy worked for you? That sucks that your insurance wouldn’t pay for it. Where I am the taxpayers pay (the outpatient clinic is on a sliding scale, the slack picked up by government funding) for it since I haven’t got much money and it costs less than it would to put me in a hospital and throw away the key. The meds are expensive as all hell (Wellbutrin and Depakote, neither of which have a generic equivalent in the u.s.), but, ironically, the insurance I have will pay for that. > So, anyway, good luck!
Thanks for the info and the chance to talk. I’m still interested in therapy for Borderline. Might be useful to me even if I don’t have the Dx.
Response:
Fletcher wrote: > Hi jen, yes there are Medicare HMO’s. You could call the 800 number for > SSA and ask them for info on HMOs that participate with Medicare in your > area.
Hi, thanks. I’ll see what they say. > all the information and sort out which HMO is best for you. Some HMOs > provide very little in terms of mental health benefits.
Medicare does very little itself. I’m just lucky that the state I live in covers it anyway. Not the meds, but everything else. > I know I am cynical but I dread hearing candidates say they are going to > improve Medicare because every time they do they reduce what it actually > covers.
Yeah, there’s some crap bill going on now about forcing drug companies to sell pharmacies drugs at a rate they sell to HMOs so that the pharmacies will pass the savings on to their Medicare customers. An absolutely ridiculous bill that does nothing to guarantee that savings will be passed on or that drug prices won’t simply be raised by the drug manufacturers. The congressman for my area sent out a mailing full of propaganda and making it sound as though Medicare were going to get an Rx benefit when it’s not. I wrote a letter to him but haven’t mailed it.
Response:
Hi jen, yes there are Medicare HMO’s. You could call the 800 number for SSA and ask them for info on HMOs that participate with Medicare in your area. It is a special arrangement between the HMO and the government. Some of these HMOs actually do provide prescription plans. You have to look at all the information and sort out which HMO is best for you. Some HMOs provide very little in terms of mental health benefits. In my area there is only one HMO provider left that will participate in this plan. The government always teases them with a suggestion of increased reimbursement and then when the program is up and running the HMO finds out they are getting less. I think you are required to have both parts of Medicare. I know I am cynical but I dread hearing candidates say they are going to improve Medicare because every time they do they reduce what it actually covers. Good luck, Abby
Response:
On Sat, 20 May 2000 18:12:15 GMT, brat/mail.cruznet.net <-=- kajira hill -=- <b…@antisocial.com>> wrote:
<<snipped some of kajira and jenwolf’s stuff>> >I’m on >disability due to borderline, but this therapy they say is not >medically necessary. *throwing hands in air*
I suspect that insurance companies feel the same way about BPD as many in the psych fileds do, that borderlines won’t improve much. Aggravating, and one of the reasons I’m so happy for Linehans work. It might not be the answer for every borderline case, but it shows that improvement is possible for many people. The book "I Hate You–Don’t Leave Me" says that borderlines might just become *better* borderlines. That always gets me wondering…but I suppose the book was upbeat at the end in spite of painting a black picture all the way through. jenwolf wrote: >::So, do people with Borderline need to take meds always? With Bipolar, I kajira wrote: >I can’t say for sure, of course, but it appears, in my experience, >that meds can somewhat stabilize a person so that they might enter >therapy. (And of course, with adjustments here and there when needed, >continue to stabilize the person.) My situation has been such that I >think my clinical depression overtook the bpd.
I think it does depend on the severity of underlying illnesses like depression of bipolar (you *can* have bipolar and BPD). I’m inclined to think, along with my therapist, that I have dysthymia (fairly low grade depressions with hypomanic states). Dysthymia sounds a lot like BPD, weird, but the difference is that the hypomanic state is maintained over days, at least four to five, where as states in BPD shift daily or hourly :-) I get that too. kajira wrote: > Each time I tried to >get help and was rejected, I got more depressed. I’ve quite a big pit >to crawl out of, now. But at least I’m crawling.
Ugh, I hear ya. I fall into that feeling just going to a regular MD for a sore throat…like, because of my mental health issues I don’t have physical ailments "for real." Very hard for me to keep my perspective clear if I feel a doc is not taking my physical problems seriously. Rejection of any kind is such a trigger. jenwolf wrote: >::can’t stop taking them anymore. Ever. At least they’ve improved from the >::old days of lithium. What types of therapy worked for you? That sucks >::that your insurance wouldn’t pay for it. Where I am the taxpayers pay >::(the outpatient clinic is on a sliding scale, the slack picked up by >::government funding) for it since I haven’t got much money and it costs >::less than it would to put me in a hospital and throw away the key. The
With bipolar I would think that meds are a way of life, for life. Manic states are sometimes fun, sometimes damaging to the person and to others, and then the down side hits and all your unrealized plans are thrown in your face, or all the nutty things you did while manic are a cause of shame or interpersonal conflict, etc. Borderline symptoms can be similar. I know that two days ago I was full of plans in the morning, bought necessary stuff to get things done, and by evening wondered what all the excitement was about. I’ve lost that driven enthusiasm, and have to be careful to not beat myself up about it…just wait around til the next wave comes. Wow, I wonder if one day mental health will really and truely get parity with other health issues. Seems like a law was passed recently here where I live, but isn’t in effect yet. Mental health problems will get the same benefits as other health issues do…same number of visits, etc. I don’t know. I wonder (they cynic in me) if insurance companies will cheat all benefits now, and specify the number of visits we can have for any problem now. Parity might be cut the other way. kajira wrote: >I went to a county mental health place too, before I was awarded >disability. At that point, I was given Medicare, and the county said >I could no longer use their facilities since I had so much more money >(oh yeah, 800/mo is BUNCHES) and Medicare.
I hate to hear stories like this. We’ve been right on the financial edge, also, and you feel so helpless. I would love to see some change in this area, but what changes, I don’t have a clue. jenwolf wrote: >::meds are expensive as all hell (Wellbutrin and Depakote, neither of >::which have a generic equivalent in the u.s.), but, ironically, the >::insurance I have will pay for that.
Insurance will just about pay for any kind of pill, and won’t care at all what your doc prescribes. If he prescribes therapy, then they freak out and want to know if "you really are depressed enough to need therapy, blah blah blah." You need a trail of paperwork saying you can have therapy, but can swallow any addictive or other substance your doc sees fit to give you without ever hearing from them. Why don’t they call every time we are given a med? "Do you really need that pill?" Why don’t we need an official document every time we a prescribed drugs? Therapy costs so so much. It’s all in the bottom line. kajira wrote: >The best therapy I’ve experienced was EMDR. But I was deep in PTSD >(acute) at the time, and I understand EMDR is used mainly for PTSD. >(Alphabet soup!) I still have major PTSD but it is more subtle. My >current therp utilizes EMDR but we’ve not yet started. We’re still >getting to know one another.
Takes time. My issues weren’t outwardly traumatic, no sexual abuse or physical abuse or major trauma like that, and it still took me years to get to the point where I could be honest with my therp about my hardest isssues. Still puzzles me why we hold back from the one person who needs to know everything, and can help the most when we are honest. –Tezza
Response:
-=- kajira hill -=- wrote: > They have an "arrangement" with a pharmacy. I have a Dept. of Mental > Health card which I would show at the pharmacy, and they were > connected via computer. Dunno all the inner workings of it, of > course, but it was a nice arrangement for us patients.
Yeah, that would be great. We don’t have anything like that here. > I’m on a Medicare HMO.
Are you sure you don’t mean Medicaid? There is a difference. I used to get both, but now I only get Medicare, which is pretty crappy for me because the bulk of my medical costs are prescriptions and Medicare doesn’t have a prescription benefit. If the SSA hadn’t decided that I was eligible for Medicare retroactively, I could have bought private insurance with no underwriting. > So it’s $30/three months through a mail-order > pharmacy specified by the HMO. If I were to get it locally, I > wouldn’t be allowed to get it 3/mo at a time, and it would cost > $20/mo. I understand that it is an expensive drug.
Yeah, I think it comes up to something like $2/pill. For the 150mg SR. Depakote costs even more. > Yeah, that not feeling safe thing really bugs me. And I can’t move. > So…
I couldn’t move either. But I did. First I stayed with some friends. Basically just threw my bed in a corner. I only brought my bed, some clothes, the dog, some stuff I’d written, a few books and the computer. Left behind everything else I owned just to get out of that town. I even lived in my car in the middle of January (in northern Michigan) rather than go back to that place. It was a war zone. Literally.
Response:
myh…@tesme.com wrote: > On 21 May 2000 13:52:01 -0500, jenwolf <jenw…@email.com> blabbed the > following > > Really, though, taxes would have to go up. I won’t get > >started on what I think about all of that or it’d turn into quite a > >rant. Basically, the people who need the care most are the least likely > >to get it. > So.. medicare tax taken out of my paycheck is so low.. it could be > doubled or tripled and I would not be bothered by it..
My husband says the same thing. And I would be more than happy to pay double the Medicare premium for a decent prescription benefit.
Response:
myh…@tesme.com wrote: > The main one is what, exactly, is the treatment for > >::Borderline PD? Maybe I’ll just leave it at that for now. > The state funded mental health clinic that my HMO forces me to go to > uses DBT on borderlines.. they tried it with me but I hated it.. so > now I get cognitive therapy..
What is DBT? I didn’t mind cognitive therapy, but it didn’t work very well with me. There are some things I learned from it though that have stuck with me for years and years.
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