Types of Borderline Personality Disorder Medications

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Borderline personality disorder (BPD) is sometimes treated with medications for anxiety or depression, which may reduce some symptoms of BPD. While there are currently no medications approved by the FDA to treat BPD specifically, some drugs have been found to be effective in some cases.

They may also be used to treat psychological conditions that frequently co-occur with BPD, such as major depressive disorder.

Medications may be particularly effective for BPD when they are used in conjunction with psychotherapy and other treatments. Learning more about the different options will help you find the right medication choice for you.

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Reasons to Use BPD Medications

There are a number of different reasons why people may want to try medications for borderline personality disorder. The important thing is to always be sure to work with your doctor to determine which medication options might be right for you based on your symptoms and needs. Some reasons you might want to try BPD medications include:

  • Reduce symptom severity: Medications may help people better manage some of the symptoms of BPD such as mood swings, irritability, depression, anxiety, and stress-related paranoia.
  • Improve functioning: Because medications may make some symptoms less severe, they may also help improve a person's functioning in a number of areas including relationships and daily living.
  • Prevent worsening of symptoms: Some symptoms of BPD may grow worse if left untreated, so taking medication to improve those symptoms may be helpful. Research has found that BPD symptoms do tend to decline in frequency and severity as people age.
  • Treat co-occurring conditions: Borderline personality disorder often co-occurs with other conditions that can interact, overlap, and make it more difficult to accurately diagnose BPD. Mental conditions that commonly co-occur with BPD include depression, anxiety disorders, eating disorders, substance use disorders, and bipolar disorder.
  • Decrease risk for suicide: BPD is associated with an increased risk of self-harm and suicide. Because medications may help reduce symptom frequency and severity, it may also lessen the risk of suicide.

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

Types of BPD Medications

There is no medication that specifically treats BPD, but there are several types of medications that may be useful for treating different symptoms. The type of medication that your doctor prescribes will depend on your specific symptoms and needs.

Antidepressants

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

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

Common antidepressants include:

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

These medications may help with sadness, low mood, anxiety, and emotional reactivity, but they do not seem to have a strong effect on other symptoms (e.g., anger, impulsivity).

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.

These drugs can have a positive effect on a variety of non-psychotic disorders, including BPD. Antipsychotics have been shown to reduce anxiety, paranoid thinking, anger/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, such as lithium, and some anticonvulsant (anti-seizure) medications have been used to treat the impulsive behavior and rapid changes in emotion that are associated with BPD. There is research to suggest that these classes of drugs may be useful in BPD.

Common mood stabilizers/anticonvulsants include:

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

Anxiolytics (Anti-Anxiety Drugs)

Because individuals with BPD also often experience intense anxiety, medications to reduce anxiety are sometimes prescribed. Unfortunately, there is very little research to support the use of anti-anxiety medication to treat BPD.

Common anxiolytics include:

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

There is also some evidence that use of a particular class of anxiolytics, benzodiazepines (e.g., Ativan, Klonopin), may actually cause a worsening of symptoms for some individuals with BPD. They should be prescribed with caution.

Benzodiazepines are particularly dangerous for use by individuals with co-occurring substance use disorders because they can be habit-forming. 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 the biological causes of BPD, new medications are being developed and tested for the disorder. Researchers are exploring new medication options for treating BPD including neuropeptide agents, cannabinoid medications, and medications that target serotonin receptors with greater specificity. 

For example, findings from one study suggest that an omega-3-fatty acid supplement can lead to decreased aggression and feelings of hostility in people with BPD.

Side Effects

As with other substances, people may experience side effects while taking medications to treat BPD. It is important to remember that each medication has its own set of side effects. Some of the more common side effects you might experience include:

  • Appetite changes
  • Constipation
  • Diarrhea
  • Dry mouth
  • Fatigue
  • Insomnia
  • Nausea

Some people may also experience allergic reactions to medications. You should seek medical attention immediately if you begin to experience symptoms of an allergic reaction. You should always talk to the doctor about both the common and rare side effects that are associated with a specific medication.

It is also important to tell your doctor about any other medications, substances, or supplements that you are taking in order to avoid potentially serious drug interactions.

Challenges

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 variance and heterogeneity in the symptoms that each person experiences.
  • Co-occurring conditions are common: This 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 of your symptoms, which is why things like psychotherapy and self-care are also important.

Precautions

There are also certain precautions that should be taken before you try 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 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

While psychotherapy is the standard treatment approach for BPD, medications can be useful for relieving and managing some symptoms. There are also things that people with BPD can do 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 your BPD more difficult. 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. Strategies such as deep breathing, exercise, visualization, and progressive muscle relaxation are just a few you might want to try.
  • Developing coping skills: Finding effective ways to deal with emotional distress and to control impulsive behaviors can also help you function better in daily life. Some things that can help you learn and strengthen your coping skills include mindfulness, social support, and dialectical behavioral therapy.

A Word From Verywell

While medications for BPD can be a useful part of your overall treatment plan, it is important to work with your doctor to determine the best approach for your needs.

There is no single treatment that is appropriate for every person with BPD. The right approach for you will depend on your symptoms, medical history, and response to treatments.

It is also important to be aware that medications are most effective when combined with other options such as psychotherapy. Talk to your doctor about what might be right for you.

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6 Sources
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