The role of medications in borderline personality disorder

assorted pills being poured into a glass bowl

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Borderline personality disorder (BPD) is a difficult 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, 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.

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.

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.

Benzodiazepines, e.g. clonazepam and lorazepam, are not recommended for use in BPD because they can worsen impulsivity and suicidality.  People with BPD may also be at increased risk for becoming dependent on benzos.

It’s been proposed that in BPD there may be dysfunction in the body’s natural opioid system.  The opioid antagonist naltrexone has shown some benefit for dissociative symptoms.  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.

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 in possible when the crisis is over.

It seems unlikely that BPD could ever be treated with medication alone, but 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 thinking that BPD is “just” a personality disorder.

If you have BPD, what has your experience with medication been?

Sources:

Have you checked out my book Psych Meds Made Simple?  It’s available on Amazon as an ebook or paperback.

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18 thoughts on “The role of medications in borderline personality disorder

  1. sophienaylor1 says:

    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.

  2. eLPy says:

    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.

  3. Meg says:

    Great blog post! It had me googling a lot of drugs I’m not all that familiar with! Interesting!

    It’s sad to think there aren’t better treatments for BPD.

    I’ve encountered some really useful self-help books on the topic. Loving Someone With Borderline Personality Disorder by Manning was great.

    The thing that makes me sad about people with borderline is that it’s not a “bad” personality disorder like narcisissim or psychopathology. I think it must be an awful struggle, and I wish there was a better pathway to happiness/peace!!

  4. Melanie B Cee says:

    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!

  5. snehaexpression.com says:

    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

  6. C. K. Realism says:

    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!!!

  7. Jeannette Whalen says:

    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!

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