Is medication effective for Borderline Personality Disorder?

[tryp]

The question of whether medication is useful or appropriate for those of us with BPD is a contentious one. It used to be thought that the Axis 1 disorders should be medicated while the Axis 2 (PDs) could only be helped by therapy.

This clinical guideline is a good review of pharmacological treatment strategies, though of course all medication ideas and questions should be discussed with one's doctor and there is no one medication that will be good or helpful for everyone with BPD.

http://psychiatryonline.org/content.aspx?bookid=28&sectionid=1672600

Edited August 4, 2013 by tryp

[Velvet Elvis]

It's mentioned in the article but I've heard a lot (mostly anecdotal evidence) about the positive use of Topamax for bpd as well as SI and ED that often all come together as a cluster.

Basically it's helpful for impulse control. If there is one thing I've noticed about borderlines I've known it's that their moods are rather impulsive, for lack of a better term. Having been on it for a number of years myself for impulse control related issues, I can see how it would work. In skimming the article I noticed that it mostly focused on Topa for anger, but it can also help with the impulsive aspects of binge eating, SI, and substance abuse that also come along with BPD.

I can dig up studies later if anyone is interested.

[LikeMinded]

All I can do is speak from personal experience here.

I have many borderline traits myself (impulsivity, black-white thinking, outward drama/hostility, rejection sensitivity, and some others -- however, I don't know whether they're caused by a bona fide Axis 2 personality disorder, "medicable" MI, or "organic" genetic/neurological illness). In fact, I was once diagnosed with this particular PD several years ago.

My personal experience is that having a mood stabilizer on board helps (in my case, Lamictal/lamotrigine). Without it, I am Seriously In A Bad Mood Ready To Snap At Anything, much like a typical borderline. Also, Cymbalta helped with the rejection sensitivity, but this is just my case.

However, I think by my experience, that the dogma is true, that therapy is the major cornerstone (even if meds are helpful in addition). I have never undergone formal DBT before, but having had a few years of CBT, I have been encouraged to see "both sides of the story" and understand that people are, after all, human and do have their "gray areas".

Edited August 22, 2011 by LikeMinded

[PeaceAndHarmony]

This is really interesting and something that I've been looking into. I am diagnosed with BPD as well as BP and my therapist and I had a long talk about the affects of meds on my BPD mood swings. I want to first say that my pdoc is one of the best in the country and I am very fortunate that she is able to work with me. We tried Risperdal first because she told me that would be a first line med to ease both the BPD moon swings as well as the BP mood swings. I had a reaction to the Risperdal so she switched me over to Seroquel. We slowly titrated up to 800mg and I had a too many horrible side effects so we went back down to 300mg and added Lithium and my moods have been rock solid since. The medications really seem to help me in conjunction with my weekly therapy. I feel it has point in a place where I am better ale to take a step back and use the positive coping skills that I've learned. I don't feel like everything is the end of the world anymore. I don't know if I would be able to accomplish all of the positive steps that I have taken without medication. That is a lot coming from me because I have always been dead set against taking any medication and it took me over a year of therapy and various hospitalizations to finally give in and give the meds a shot

Peace

[tryp]

I don't know that many medications have done much for my BPD, personally. Except for Seroquel, which is basically my God. I haven't often had anything so gnarly in my head that 50 mg extra of Quel couldn't at least tone it down.

[AtomicUniverse]

I'm diagnosed with BPD

The Good:

Zyprexa - Second day on it and I'm noticing a better ability to regulate emotions. On 5 mg

Seroquel - It was good for a while, but in the past two years I've gotten substantially worse so it wasn't really effective any more. Was up to 200 mg

Nortriptyline - Currently on 100mg, which may be too much. Around 50 or 75 mg (I spent a week on 50 and a week on 75mg) I noticed an effect, but that has since gone away

The Bad:

Effexor - Flipped my rage switch on almost all the time. Was up to 325mg.

Any SSRI - Didn't notice any good effects or the side effects were too nasty to deal with

Topamax - I couldn't deal with the numb and tingly feeling. Was up to 75mg on the third week when I stopped.

Geodon - Really nasty, nasty anxiety - feeling of sheer terror for no reason. Ugh. I get anxiety just thinking about it. Took one 60mg pill.

Depakote - Allergic to it. Gained 20 pounds in a month and a half on 1000mg, then at 1500 they realized I was allergic.

The Meh:

Wellbutrin - Didn't have any positive effects after two months. I just felt stupid and air headed. Up to 450mg

Serzone - Didn't work. I don't remember the dosage.

Abilify - It just made me stupid and didn't help with moods. I was up to 5mg.

I get really annoyed when I hear that some doctors don't prescribe meds for borderline patients. Some medications have been helpful for me. They're not going to help if the patient isn't going through therapy that's shown to be effective for people affected with BPD, but they definitely provide some relief, especially through a crisis situation.

[zzoee]

I have been diagnosed with bpd, been on paxil for about five years and kind of wondering how I'd be now without it...

I've gotten into a little kleptomania so I do t think it's helped with impulse control...

[hallowedink]

Looking at that article... I don't know. My psychiatrist flat out told me she didn't prescribe for BPD. However, she did say that it was alright for me to continue my treatment plan with my GP (he prescribes me my psych meds) if I wanted to, and thought it might to be some good. She did say that I'd be lucky to find something that worked though.

One the other hand, I pretty much swear by seroquel at the moment. That's just personal experience though. And it hasn't made an enormous all-round improvement. It just makes me feel a little bit more sane, which in turn makes it easier for me to interface with therapy, which is always a good thing.

N

[leadinglady]

I think that the symptoms of BPD can most certainly be helped with medication. I haven't found one yet, though. I've been on Paxil for 20 years or so and liked the Zyprexa/Paxil combo I took for awhile but Seroquel is the only thing that takes away the suicidal thoughts. I always always have suicidal thoughts if I'm not taking Seroquel, even though I truly do not like it. I had read about carbemazepine and Prozac being sort of the gold standard of BPD treatment. The dysphoria is awful. That's the worst part of all of it. That feeling of dread and pessimism. It sucks. Sometimes I do wonder if the Paxil has made my symptoms worse. I will never understand when an anti-depressant is prescribed and then the side effects say "may cause suicidal ideation" "may cause depression" "may cause anxiety".. well wtf did you put me on it for then!? Grr! Venting. lol

[Anna]

I am a big believer in meds for BPD, I don't have studies but I've seen some things work in action. Mood stabilizers, (particularly lamictal, depakote, and topamax) seem to have some efficacy. As well as some of the AAPs. Granted, I think therapy also plays a big role, but I do believe some of the mood swings and impulsivity can and do respond to medications.

Interesting study, I remember reading a study on the positive effects of depakote on BPD but can't find it anymore.

Anna

[simmonjl]

finally found people who describe me to a T. Boderline, so good to know we are not alone.

[amanda88]

I have BPD and am on the following meds:

lithium - to regulate mood

Seroquel - to help with anxiety and intrusive thoughts

Abilify - help with intrusive thoughts

Wellbutrin - for depression and motivation

Pristiq - Depression

These meds really to help my symptoms of anxiety/depression/thoughts/SI/impusive behaviours...but they don't get at the "root" of the problem. I still create chaos, and I still have stormy relationships. However, I feel blessed that these meds control what they do.

[pinktee18]

I have found that I can't function without some kind of medication due. to my anxiety and highs and lows associated with borderline personality disorder that are almost a combination of bipolar. Lamictal was my life saving drug, but stopped working after awhile and my pdoc just put me on depakote and klonopin. It's only day two so I can't for sure feel anything just yet but I'm willing to give it a chance. I've tried not using medication, but when I don't take anything I crash and go so low that I scare myself.

[crazy_cat_lady]

I only recently received a dx for BPD, but received treatment for it as well as Bipolar Type 2 for years. I've been off meds for almost 4 years and am not sure how I've made it this far... (pdoc says I'm "high functioning" for a borderline). In 2 weeks I am supposed to start with antidepressants and mood stabilizers again. Eep. I was on all kinds of medication from the age of 12 until I was 19; not sure if some of my bad reactions to meds were because I was an adolescent or if I actually had a negative reaction. Also, my pdoc at the time was not super... For posterity, I'll share my experience:

Citalopram (Celexa): this was the first antidepressant I was prescribed, and after several months I didn't notice any changes

Risperidone (Risperdal): put me to sleep almost constantly; I couldn't stand the fatigue and empty feeling

Quetiapine (Seroquel): was really sleepy for the first 2 weeks, then noticed that it helped regulate my emotions fairly well, but the effect wore off after about a year and my pdoc switched my meds

Olanzapine (Zyprexa): not sure if I was allergic to this, but I had 2 seizures while on Zyprexa. I also couldn't stand the numbness and inability to feel anything anymore. It also made my memory terrible, like I was in a constant haze.

Lorazepam (Ativan): for panic attacks; this was a GREAT drug, but it was quickly habit-forming and I started taking it all the time to prevent panic attacks from starting in the first place; pdoc promptly took me off it due to my "addictive tendencies"

Lithium: I had severe dry mouth, and was unable to feel much of anything for a while. Once I stabilized on a better dosage, it was actually a pretty good drug for regulating emotions.

Venlafaxine (Effexor XR): I agree with the previous post that said it flipped my rage switch on constantly. Because of BPD, I already have trouble controlling anger (up to and including blackout rage in which I have attacked people, broken things, punched holes in walls, and don't remember any of it), and I couldn't control the constant angry outbursts on this drug. It was also the most difficult to get off of; it took me 3 years, several failed attempts, and a great deal of emotional/psychological pain to get off Effexor. This drug is THE reason I stopped taking meds at all. Probably didn't help that I started taking it when I was 14, and was up to 325mg (at least) within 2 years.

I don't know what other meds I have taken as well; my pdoc at the time convinced my parents not to tell me what I was taking, so they hid pill bottles from me, and gave me a handful of pills to take twice a day that I didn't know anything about. I think I might have taken Mellaril as well, but can't remember any effects. Essentially, long periods of a month or more at a time are just blacked out in my memory of my teens because I was so drugged up all the time. The pros about being off meds are that I can feel things again, but the cons are that I feel everything WAY TOO MUCH, all the time. At least now I'm old enough (and educated enough) to do my research before taking any meds I'm not sure about. Also have a way better pdoc and am on waitlist for DBT. Hope this helps anyone interested...

[Borderliner]

I had great response for BPD with vyvanse. I made a post about it.

Maybe we need something more immediate I think. Everyone is different though.

Controlling your feelings with downers its the psychs first choice, allways. The fact is, we have the most difficult disorder to treat, any doc would be afraid to prescribe anything abusable cuz they dont want to test us for that. Only you know yours limits. It looks like we are in some kind of limbo, seeing others as what we should be. However, sometimes the opposite. Or even not decided or decided to not be "black or white" and be the two. I believe most think like this. anarchists in mind and plus attitude.

[sinisteria]

Hey people,

I don't understand anything about medication. Some years ago, I got help from combining something like therapy (poor man's therapy so to say) and a medicine called : citalopram ? anyone ? Now I'm on it again, and I suppose it helps a little... I take just 20 mg.

It's supposed to be a medicine that stabilizes the moods. But I don't know, is it actually an ssri -med?

At one point I took similar med to effexor, called venlaflaxin actavis, and it made me puke everyday, could not sleep, had anxiety, and my boyfriend left me - he told me i had a rage-episode, but actually i just sent him a textmessage.. i suppose it could've been rage...but to me it was anger.

Anyway, I think that the effexor had a bad influence on me.

Does someone know anything about my meds `?

[sinisteria]

Ok, Crazy_cat_lady,

you seemed to have written about the meds I've tried "on" already. Thanks for that.

Efexor really seems to be the devil for BPD:s ???

[Velvet Elvis]

She sent me a PM asking to have her account removed.

[Crazylu77]

The only thing that's worked for me is a combo of Paxil CR, Seroquel XR, Buspar, and Focalin XR (for impulse control/ADHD). I also take Naltrexone and Wellbutrin XL (to prevent from wanting to relapse/alcoholism)

[pa_canuck]

Seroquel really really helps me....800 mg . I'm glad it does...but ymmv.

Take care.