Borderline personality disorder (BPD) is a hard-to-treat condition that can cause significant distress for those living with it. While the gold standard for treatment is psychotherapy, specifically dialectical behaviour therapy (DBT), medications may also play a supporting role, and that’s what this post will focus on.
Antidepressants
Antidepressants, particularly SSRIs, are some of the most commonly used medications in BPD, but research has demonstrated only moderate effectiveness. The tricyclic antidepressant amitriptyline has shown somewhat better results, but it can be lethal in overdose, which is not necessarily the best fit for an illness that often combines impulsivity with suicidality.
Mood stabilizers
The mood stabilizers topiramate, lamotrigine, and valproic acid have shown some benefit in research studies. Additionally, valproic acid may be able to reverse some of the changes in gene expression that result from childhood trauma.
When there is a family history of bipolar disorder suggesting a genetic predisposition, a mood stabilizer like lithium or lamotrigine may be helpful.
Antipsychotics
The atypical antipsychotic olanzapine has demonstrated effectiveness in reducing impulsivity, hostility, mood lability, and psychotic symptoms. However, there appears to be an increase in the risk of self-harming behaviour.
The older antipsychotic haloperidol may be useful for anger, although for the most part, it’s newer antipsychotics that have shown the most benefit in BPD.
Benzos
Benzodiazepines, an anti-anxiety class of medication that includes clonazepam and lorazepam, are not recommended for use in BPD. The main concern is that they can worsen impulsivity and suicidality. People with BPD may also be at increased risk of becoming dependent on benzos.
Other potential options
One suggested contributing factor to the development of BPD is dysfunction in the body’s natural opioid system. The opioid antagonist naltrexone has shown some benefit for dissociative symptoms, which can be relevant for BPD. Further research in this area may turn up some new potential treatment options.
Some studies have suggested that irritability and aggression may be related to changes in levels of the hormone vasopressin. These changes in the regulation of vasopressin, as well as the feel-good hormone oxytocin, may be the result of changes in gene expression that result from early life trauma. The administration of vasopressin to manage symptoms of BPD is an area for future research.
The role of meds
Overall, there’s not a lot of research evidence when it comes to medication use in BPD. Even when drugs have shown some benefit, there are many core symptoms of BPD that they do not address, and they do not appear to decrease the overall severity of the illness. It’s recommended that medications only be used on a time-limited basis as adjuncts to psychotherapy, and polypharmacy (aka being on multiple medications at the same time) should be avoided. Medications that are added during a time of crisis should be withdrawn, at least if possible, when the crisis is over.
It seems unlikely that BPD could ever be treated with medication alone, given the nature of the condition. Still, people living with BPD certainly deserve better than the under-researched hodgepodge that is the current state of affairs. It’s hard not to wonder if the type of research that’s been done has been influenced by stigmatized thinking that BPD is “just” a personality disorder.
If you have BPD, what has your experience with medication been?
You can visit the post What Is… Borderline Personality Disorder for all things BPD on MH@H.
References
- Chanen, A.M., & Thompson, K.N. (2016). Prescribing and borderline personality disorder. Australian Prescriber, 39(2), 49-53.
- Olabi, B., & Hall, J. (2010). Borderline personality disorder: Current drug treatments and future prospects. Therapeutic Advances in Chronic Disease, 1(2), 59-66.
- Ripoli, L.H. (2013). Psychopharmalogical treatment of borderline personality disorder. Dialogues in Clinical Neuroscience, 15(2), 213-224.
- Stoffers, J., et al. (2010). Drug treatment for borderline personality disorder. Cochrane Review.
- Stone, M.H. (2019). Borderline personality disorder: Clinical guidelines for treatment. Psychodynamic Psychiatry, 47(1), 5-26.
Want to know more about psych meds and how they work? Psych Meds Made Simple is everything you didn’t realize you wanted to know about medications.
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Ashley L. Peterson
BScPharm BSN MPN
Ashley is a former mental health nurse and pharmacist and the author of four books.
Completely agree that BPD deserves more recognition and understanding from mental health professionals. It’s often swept under the rug as people don’t take the time to research and try to understand it.
Yeah, it’s really unfortunate.
It’s sad that people are so unaware of BPD, I imagine we all agree that were it more visible more people could be helped. It can be so devastating for the person suffering BPD as well as their family and yet it’s relatively unknown to the public, compared to say Bipolar and OCD, IMHO. Thanks for this information.
Yes there seem to be stereotypes about it but not a lot of accurate information.
My mother was most probably an un-diagnosed BPD sufferer. I am finding, that as I age, I’m showing distinct signs of BPD myself (at least the anger part of it). The suicide portion has always been a problem for me. I am on anti-depressive medication and anti-anxiety medication, but neither help very much with my anger. This is something I plan to address with my therapist the next time I see her (at the end of June). Thanks for sharing the information Ashley-leia!
I hope your therapist is able to come up with some useful ideas.
Me too. If this (my state of mind and temperament) are what my mother experienced, I understand so much better why she was ‘how she was.” And why nobody wanted much to do with her in the last years of her life.
This is such an amazing post. I suffer from either BPD or Bipolar because I have always had extreme mood swings, along with happy and low phases. But nobody believes me. In India, people are not understanding enough to believe regarding mental disorders. Friends and family just feel I am overtly emotional, sensitive and should learn to control my feelings. I am so glad I stumbled upon your website. Followed your blog
Lots of love,
Sneha
That’s so unfair. What you feel is valid.
I love this post! I take lamotrigine and it helps me really good to stabilizing my mood.
That’s great!
This is really well researched, thank you for the information. I literally just wrote a blog post on my site about the effects of medication in a crisis with BPD.
I enjoyed reading your post. I has BPD along with other mental health diagnosis. The challenge with medications in the past were doctors picking which mental health disorder to treat. At one point, I was on 10 medications at once. To add more complexity I have autism. Some medications interacted negatively with my developmental challenges. In a nutshell, I have had no positive experiences with treatments for my mental health. At this point, I am not on any medications and attempt to use positive coping methods for my symptoms. Although, my dissociative episodes are an issue for me with my BPD and I may need to look into medication once more. Any way, Loved the information you provided!!!
That’s too bad it’s been so hard to find something that works.
Hi, I have been diagnosed with BPD. I’m on Effexor, Abilifiand gabapintin. When stress really hits it all just not quite enough. I understand it’s hard to treat. But then there should be even more people studying the illness. Great article. Loved it!
More people studying it would definitely be a good thing.
I have BPD and so far all the medications I have tried just seem to make me feel worse.
Oh that sucks 🙁
I was on Quetiapine for a year and now I’m on Lamotrigine and Citaloprm which has been more helpful and I’ve been on Lamotrigine for I think six years now. The NHS here in the UK is so stretched thin that it’s easier to just bung us all on meds, especially if group therapy has failed to be an option.
It’s unfortunate that it works out that way.
I was previously on a anti psychotic (fluanxal ?) I’m not sure how to spell it. And clonazepam as well as sertraline. Now I just use sertraline and lorazepam (on occasion). The sertraline I find is okay…. the anti psychotics with the clonazepam turned me into a zombie. I don’t know how I function.
Fluanxol’s old-school, and yeah, pretty prone to side effects.
Yep, it is. I tried like 5 others before hand and they just made everything worse. Wellbutrin was the WORST
It’s fine, I’m not on antipsychotics anymore 😉