BPD Medications: Types, Side Effects, & Management

Are There Medications for Borderline Personality Disorder (BPD)?

While there are currently no FDA-approved medications for borderline personality disorder, healthcare providers can prescribe certain off-label medications to address symptoms.³ Borderline personality disorder is a chronic mental health condition under the category of personality disorders and is marked by instability in a person’s mood, self-image, and interpersonal relationships.¹ While there is no cure for BPD, certain medications can be effective in BPD treatment when combined with therapy.³

The Importance of Therapy for BPD

Therapy is considered the first step when determining how to treat BPD as it teaches skills to cope with distress, regulate emotions, and resolve relationship conflicts. Without therapy, recovery from BPD can be challenging.

When Would Medication for BPD Be Prescribed?

Medications for BPD may be prescribed for reasons such as:

• Reduce symptom severity and frequency: Mood changes, impulsivity, and self-injurious behaviors are all targeted symptoms.
• Improve overall functioning: BPD can be very debilitating, but medications can help restore a desirable level of functioning.
• Treat co-occurring conditions: Since BPD commonly co-occurs with depression, anxiety, and substance use disorders, medications can improve those symptoms.
• Decrease risk of suicide: Suicidality is an unfortunate effect of BPD. By treating the risk of suicide, professionals can improve safety.
• Improve treatment outcomes: When someone with BPD is not using medication, it may be challenging to keep them in treatment. With medication, they may be more likely to attend sessions and keep a routine.

Types of BPD Medication

There are not any specific approved borderline personality disorder medications, but there are plenty of medication options for someone with BPD. Medication for BPD may take some trial and error, but good results can be achieved.

Antidepressants for BPD

Antidepressants like selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are the most commonly prescribed antidepressants for individuals with BPD who are experiencing symptoms of depression.³ These medications prevent the reabsorption of serotonin and norepinephrine, which increases the amount of these chemicals available in the brain.

Celexa or Zoloft for borderline personality disorder have been found to help with mood instability and impulsivity. By reducing the person’s mood symptoms, they can improve their overall well-being.¹⁶

MAOIs have shown good benefit with BPD, especially with aggression, anxiety, mood instability, and sensitivity to rejection. The problem with MAOIs is that their side effects tend to be problematic for a significant number of people.¹⁷

Types of antidepressants for BPD include:³

• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Venlafaxine (Effexor)
• Duloxetine (Cymbalta)
• Fluvoxamine (Luvox)
• Bupropion (Wellbutrin)
• Fluvoxamine (Luvox)
• Paroxetine (Paxil)
• Phenelzine (Nardil)
• Tranylcypromine (Parnate)

Side Effects of Antidepressants

Antidepressants can cause a range of side effects, the most common being fatigue.⁴ For some people, side effects like weight gain may occur when first starting a medication and gradually go away. If you’re taking antidepressants and begin to experience suicidal thoughts, talk to your doctor immediately. It can also be helpful to speak with your doctor about how you can expect to feel while taking antidepressants prior to doing so.

Side effects of antidepressants may include:⁴

• Fatigue
• Dizziness
• Headache
• Low blood pressure
• Sweating
• Swelling
• Dry mouth
• Low libido
• Weight gain or loss
• Constipation
• Suicidal thoughts

Antipsychotics for BPD

Antipsychotic medications are sometimes prescribed to treat psychotic symptoms in people with BPD (like paranoia, delusions, hallucinations, and dissociation).³ Antipsychotics fall into three categories: first, second, and third-generation. Second and third-generation antipsychotics are most commonly prescribed for BPD because they cause milder side effects and are generally better tolerated than first-generation antipsychotics.

Types of antipsychotics for BPD include:³

• Aripiprazole (Abilify)
• Ziprasidone (Geodon)
• Risperidone (Risperdal)
• Quetiapine (Seroquel)
• Olanzapine (Zyprexa)

Side Effects of Antipsychotics

Antipsychotics can cause mild to severe side effects. Long-term use can lead to tardive dyskinesia, a condition that involves involuntary movements of the face, neck, and tongue.⁵ In some cases, the effects can be permanent. If antipsychotics are prescribed, healthcare providers will monitor you closely and may prescribe other medications to help prevent or manage side effects.

Side effects of antipsychotics may include:⁵

• Sedation
• Dizziness
• Headaches
• Low blood pressure
• Weight gain that can result in diabetes
• Dry mouth
• Increased saliva
• Blurry vision
• Tremors or stiffness
• Menstrual changes
• Sexual dysfunction

Mood Stabilizers/Anticonvulsants for BPD

Mood stabilizers and anticonvulsants are prescribed to treat anger, impulsivity, and mood instability in people with BPD.³ Some of these medications were developed to prevent seizures in people with epilepsy, but they can also reduce manic and depressive symptoms. People with co-occurring bipolar disorder may benefit from a mood stabilizer.

Types of mood stabilizers/anticonvulsants include:³

• Lithium (Lithobid)
• Lamotrigine (Lamictal)
• Sodium valproate (Depakote)
• Topiramate (Topamax)
• Oxcarbazepine (Trileptal)
• Carbamazepine (Tegretol or Carbotol)

Side Effects of Mood Stabilizers/Anticonvulsants

Mood stabilizers and anticonvulsants can cause serious side effects.⁶ High levels of certain medications can have toxic effects. For example, taking lithium poses a risk of kidney issues. Because of this, prescribers closely monitor patients and may request that they have their blood levels regularly checked while on these medications.

Some of these medications can also be dangerous to take during pregnancy or while breastfeeding. If you are pregnant or have plans to become pregnant and are considering mood stabilizers and anticonvulsants, be sure to speak with your doctor.

Common side effects of mood stabilizers and anticonvulsants are:⁶

• Nausea, vomiting, or diarrhea
• Drowsiness
• Dizziness
• Low energy
• Blurry or double vision
• Tremors
• Weight gain
• Bruising
• Rash
• Hair loss
• Electrolyte imbalance

Anti-Anxiety/Anxiolytics for BPD

Anti-anxiety and anxiolytic medications may be prescribed to people with BPD who also suffer from anxiety (e.g., generalized anxiety, social anxiety, or panic disorder). Benzodiazepines are a type of anti-anxiety medication that can help reduce acute anxiety during panic attacks.⁷ They’re usually prescribed on a short-term basis because they have a very high addiction potential that can result in dangerous withdrawal. These medications may be taken PRN (as needed) when you feel significant anxiety coming on.

Types of anti-Anxiety/anxiolytics include:⁷

• Alprazolam (Xanax)
• Lorazepam (Ativan)
• Clonazepam (Klonopin)
• Diazepam (Valium)
• Buspirone (Buspar)

Side Effects of Anti-Anxiety/Anxiolytics

Benzodiazepines carry a risk of addiction and severe withdrawal symptoms.⁸ Because of this, benzos are typically prescribed for short periods of time and patients are closely monitored. People taking benzos should avoid alcohol, opioids, and barbiturates, because these substances could increase the risk of an overdose. If you have a history of addiction, be sure to share this with your provider before taking benzos.

Common side effects of anti-anxiety and anxiolytics are:⁸

• Nausea, vomiting, or diarrhea
• Drowsiness
• Disorientation
• Tremor
• Headache

Other Borderline Personality Disorder Medications

Because borderline personality disorder is such an impactful condition, new medication options are being explored to identify the most helpful alternatives. By trialing helpful medications from other conditions, experts are hoping to find success for BPD as well.

Other drugs for borderline personality disorder may include:

• Anti-dementia drugs: Anti-dementia drugs, memantine specifically, have been studied for those with BPD for their ability to regulate neurotransmitters linked to chronic stress, impulsivity, and self-harm. The findings are encouraging but remain unclear.¹⁸
• Anesthetics: One anesthetic, ketamine, is developing a reputation of improving mental health symptoms, and investigations are underway to study ketamine’s impact on BPD. Ketamine may decrease suicidality and improve mood.¹⁹
• Facial paralysis drugs: Glabellar botulinum toxin (Botox) injections have shown promise with major depression, so research is being conducted with BPD. Although people receiving Botox improved their symptoms, the improvements were not significant compared to placebo.²⁰
• Omega-3-fatty acid supplements: These supplements have a history of physical health benefits, and now experts are investigating omega-3s on BPD. Early findings show the supplements can be helpful in improving mood and reducing impulsivity when added to an established treatment plan.²¹

How to Find Medication for BPD

When seeking a prescriber for BPD medication, trust is a crucial factor. If you do not trust them, and if they do not trust you, the treatment will suffer. Practice honesty and openness to find the best medication for BPD.

Finding the right medication regimen can take time. During your first appointment with a psychiatrist, you will have a chance to share your history and current symptoms. They will ask you about your experience on other medications, including any side effects you might have experienced.

Your provider will share their recommendations and give you an opportunity to ask questions. They may be able to find the right medication(s) for you right away, or you may have to try more than one. When taking a new medication, it can help to keep a journal of how you are feeling and any side effects that you experience and share it with your prescriber. This can help you both work together to find the right medication(s) for you.

What Is The Best Medication For BPD?

Technically, there’s no “best” BPD drug because people with BPD have a broad spectrum of symptoms that vary among each individual. In fact, some experts believe there are different types of BPD.¹⁴ For example, a person with quiet BPD may struggle more with depression and avoidance, while a person with impulsive BPD may be more prone to self-harm and suicidal ideations. The best medication for BPD depends on the specific presenting symptoms.

People with BPD often have other mental health conditions (i.e., comorbidities). In fact, nearly 85% of those with BPD also have another mental health disorder.² Finding the right medication regimen will depend on addressing all mental health concerns. For example, someone with BPD who also suffers from obsessive-compulsive disorder (OCD) might benefit from medications for both disorders. Failing to treat all symptoms may hinder their recovery.

Things to Consider Before Taking Medications for BPD

Medications are never a perfect answer for someone with a mental health disorder, and BPD is a great example of that. For every improvement, there is a chance for an unwanted side effect.

Challenges that may result from taking medications for borderline personality disorder include:

• Interactions with other medications: Drug interactions are possible with all medications. Be sure to tell your prescriber about all medications, supplements, and over-the-counter medications you take.
• Multiple treatment approaches are necessary: At times, multiple medications may be needed to effectively treat the condition, which means one medication may interfere with the benefit of another.
• Certain medications can be habit forming: A few medications that may be prescribed for BPD treatment could be habit forming. Be sure to always take medications as prescribed.
• Treating co-occurring conditions: If depression, anxiety, substance use disorders, or other mental health conditions are present, they can confuse the overall treatment picture and make medication decisions challenging.
•  Lack of insurance: Without some type of insurance plan, medications for BPD could be out of reach due to expense.
• Increased suicidal thoughts: Some medications, like SSRIs in some instances, can actually increase suicidal thoughts and actions in the short-term. Always let your prescriber know about these changes.

Does Insurance Cover BPD Medication?

As long as a licensed prescriber recommends the medication for a legitimate medical reason, insurance companies should pay for the drug. If you have high co-pays, you could consider supplemental coverage like a state or federally-funded insurance program. 1-2 paragraphs.

People who still experience barriers could pursue assistance from organizations like the PAN foundation and RxHope.

Questions to Ask Your Doctor

Beginning a new medication for BPD can be overwhelming. You will likely have questions and concerns. Don’t hesitate to ask your provider any questions you may have before starting a new medication or changing the dose of your current medication. It can even help to write down your questions in advance and bring them with you to your appointment.

Here are some questions to ask your doctor before beginning a new medication for BPD:

• How should I take this medication?
• How will I know if it’s working?
• What side effects are common with this medication?
• What should I do if I experience side effects?
• Are there any other risks?
• Are there any foods, supplements, or other medications that I should avoid?
• What should I do if I miss a dose?

How to Cope With Borderline Personality Disorder

Borderline personality disorder is not a condition that typically gets better without concerted efforts. To find the wanted improvements, people have to work hard and dedicate their energy to recovery.

Here are several tips for coping with symptoms of BPD:

• Treat co-occurring conditions: If you are not well physically and emotionally, your BPD symptoms may not improve. Take care of your co-occurring conditions.
• Practice stress management: Stress makes all conditions worse. Spend some time each day working towards stress reduction and prevention.
• Adopt healthy coping skills: Coping skills can be positive or negative, so find the ways that lead to long-term benefit, even if they make things harder short-term.
• Start a mindfulness routine: Mindfulness helps you feel more in touch with yourself and your surroundings. It can reduce impulsivity and boost decision-making.
• Seek social support: Trusted friends and family members can always help cushion high stress situations. Surround yourself with stable, consistent people.
• Maintain physical activity: Sleep, diet, and exercise all improve your mental status. Take care of your physical health to improve your mental health.