Medication for BPD: Types, Side Effects, Challenges

Antidepressants

Antidepressants were developed for people with major depressive disorder and other disorders characterized by low mood. But many people with BPD are treated with these medications as well.

There are many types of antidepressants that have been studied for use with BPD. These include tetracyclic and tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs), and selective serotonin reuptake inhibitors (SSRIs).

Common antidepressants include:

• Effexor (venlafaxine)
• Nardil (phenelzine)
• Prozac (fluoxetine)
• Wellbutrin (bupropion)
• Zoloft (sertraline)

Antipsychotics

The term “borderline” was coined because early psychiatrists believed that the symptoms of BPD were “on the border” between neurosis and psychosis. For this reason, some of the first medications tested for BPD were antipsychotics.

Antipsychotic drugs can have a positive effect on a variety of non-psychotic disorders, including BPD. They have been shown to reduce depression, anxiety, paranoid thinking, anger or hostility, and impulsivity in patients with BPD.

Common antipsychotics include:

• Abilify (aripiprazole)
• Geodon (ziprasidone)
• Risperdal (risperidone)
• Seroquel (quetiapine)
• Zyprexa (olanzapine)

Mood Stabilizers/Anticonvulsants

Medications with mood-stabilizing properties and some anticonvulsant or anti-seizure medications have been used to treat the impulsive behavior and rapid emotional changes associated with BPD. And research suggests that these classes of drugs are frequently prescribed to people with BPD.

Common anticonvulsants and mood stabilizers for BPD include:

• Depakote (valproate)
• Lamictal (lamotrigine)
• Lithobid (lithium)
• Tegretol or Carbatrol (carbamazepine)

Anxiolytics (Anti-Anxiety Drugs)

Because individuals with BPD also often experience intense anxiety, medications to reduce anxiety are sometimes prescribed. Common anxiolytics include:

• Ativan (lorazepam)
• Buspar (buspirone)
• Klonopin (clonazepam)
• Valium (diazepam)
• Xanax (alprazolam)

Unfortunately, there is very little research to support the use of anti-anxiety medication to treat BPD. There is some evidence, however, that the use of benzodiazepines (e.g., Ativan, Klonopin)—a particular class of anxiolytics—may actually cause a worsening of symptoms for some individuals with BPD.

Benzodiazepines are categorized as a Schedule IV controlled substances, which means there is a risk for physical and psychological dependence. They are legal when prescribed by a licensed medical professional and should be used only as directed.

Buspar, an anxiolytic that is not habit-forming, is an alternative to medications from the benzodiazepine family.

Other Borderline Personality Disorder Medications

As we learn more about BPD, new medications are being developed and tested for the disorder. Researchers are exploring anti-dementia drugs, anesthetics, and facial paralysis drugs to learn more about their effects on BPD. This research is ongoing and more evidence is needed to learn more about the uses and efficacy of such medications.

Findings from one study suggest that an omega-3-fatty acid supplement may lead to decreased aggression and feelings of hostility in people with BPD. However, further research is needed before omega-3 supplements can be recommended for relieving BPD symptoms.

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Side Effects of Medications for BPD

As with other medicines, people may experience side effects while taking BPD medications. It is important to remember that each medication has its own set of potential side effects. That said, some of the more common side effects include:

• Constipation
• Dry mouth
• Dizziness
• Sedation
• Weight gain

Always talk to your healthcare provider about both the common and rare side effects associated with your specific medication so you know what to expect. It is also important to tell them about any other medications, substances, or supplements you are taking to avoid potentially serious drug interactions.

Challenges When Taking BPD Medications

There are a number of challenges that can affect the use of medications to treat BPD. These include:

• People have differing needs: There tends to be a high degree of variability in the symptoms that each person with BPD experiences.
• Co-occurring conditions are common: Having another condition can complicate medication choice. For example, antidepressants should not be used in cases where someone also has bipolar disorder because these substances can trigger manic episodes.
• Multiple approaches may be necessary: Medications may not be able to manage all BPD symptoms, which is why things like psychotherapy and self-care are also important. Plus, it’s not uncommon for someone with a borderline personality disorder to be prescribed numerous medications.

Precautions When Taking Medication for BPD

There are certain precautions to take before trying a medication to treat BPD. Some concerns to think about include:

• Benzodiazepines may worsen symptoms for some individuals. Research suggests that benzodiazepines may worsen the symptoms of impulsivity and suicidality in people with BPD, so their use is discouraged.
• Some medications, such as benzodiazepines, may be habit-forming. Research also suggests that people with BPD may be at a higher risk of benzodiazepine dependence, potentially due to efforts to self-medicate.
• Antidepressants carry a black-box warning. This warning notes that antidepressants are associated with an increased risk for suicidal thinking in young people.

Coping With BPD

While psychotherapy is the standard treatment approach for BPD, medications may be useful for relieving and managing some symptoms. There are also steps that people with BPD can take to improve their ability to cope. These include:

• Treating co-occurring conditions: Other mental health conditions such as substance use, anxiety disorders, depression, bipolar disorder, and post-traumatic stress disorder (PTSD) can make managing BPD more challenging. Treating those co-occurring illnesses can help you feel better.
• Finding ways to manage stress: Stress can play a major role in exacerbating the symptoms of BPD, so finding ways to reduce or manage stress can be helpful. These might include deep breathing, exercise, visualization, and progressive muscle relaxation.
• Developing coping skills: Finding effective ways to deal with emotional distress and control impulsive behaviors can also help you function better in daily life. Mindfulness, social support, and dialectical behavior therapy can help improve coping skills.