Taking Antidepressants for Borderline Personality Disorder

While psychotherapy is considered the central aspect of treatment for borderline personality disorder (BPD), many people are prescribed antidepressants for BPD. No medication is FDA approved to treat BPD, but many have proven to be effective in reducing some of the symptoms of BPD.

Antidepressants are one of the most commonly prescribed classes of medications for BPD. While antidepressants alone will not produce a full recovery from BPD, they may help you get your symptoms under enough control that psychotherapy will be more helpful to you.

Antidepressants for BPD may be recommended if you have comorbid depression, anxiety, or if your psychiatrist expects that they with help with your symptoms related to the BPD.

Types of Antidepressants

There are many different types of antidepressants. The most commonly prescribed antidepressants are called "selective serotonin reuptake inhibitors" or SSRIs. These medications work by altering the availability of the neurotransmitter serotonin in your brain. Some examples include:

• Celexa (citalopram)
• Lexapro (escitalopram)
• Prozac (fluoxetine)
• Zoloft (sertraline)
• Paxil (paroxetine)

Other types of antidepressants that are prescribed include the serotonin-norepinephrine reuptake inhibitors (SNRIs), the "tricyclics," and the "monoamine oxidase inhibitors," or MAOIs. These medications are older and have more serious side effects, so they are less commonly prescribed.

Some tricyclics include:

• Elavil (amitriptyline)
• Anafranil (clomipramine)
• Tofranil (imipramine)

Some MAOIs include:

• Nardil (phenelzine)
• Parnate (tranylcypromine)

Finally, there are other types of antidepressants that are commonly prescribed, including:

• Wellbutrin (bupropion)
• Remeron (mirtazapine)

Are Antidepressants Effective in Treating BPD?

A number of research studies have demonstrated that certain types of antidepressants are effective in treating specific symptoms of BPD. For example, SSRIs can reduce emotional instability, impulsivity, self-harm behaviors, and anger. MAOIs have also been shown to effectively treat emotional instability.

There is less consistent evidence that tricyclic antidepressants are helpful for people with BPD. While there is evidence that some people with BPD respond well to this type of antidepressant, there are significant risks of overdose.

Risks and Side Effects of Taking Antidepressants

Risks and side effects of antidepressants can vary depending on the type of antidepressant you are taking. SSRIs tend to have the least serious side effects but can produce effects such as digestive distress, headaches, insomnia, sedation, and sexual dysfunction.

Tricyclic antidepressants can also produce dry mouth, blurred vision, weight gain, seizures, and heart problems. For those taking MAOIs, certain foods that are high in the amino acid tyramine (e.g., soy sauce, aged cheese) must be avoided due to a risk of severely elevated blood pressure. In addition, there are several types of medications that have serious interactions with MAOIs, so always discuss your current medications with your doctor and pharmacist.

Questions for Your Psychiatrist

You should talk to your psychiatrist before you start taking any type of medication for BPD. If you have any concerns (including some of those discussed above), let your doctor know. Make sure you understand the risks and side effects and be sure to have an in-depth discussion about the reasons you are being prescribed a certain medication.

Borderline Personality Disorder Discussion Guide

Get our printable guide to help you ask the right questions at your next doctor's appointment.

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