Medication for Borderline Personality Disorder (BPD) can help treat symptoms associated with BPD such as depression, mood instability, anxiety, anger, and impulsivity. There are several different types of BPD medications, including antidepressants, antipsychotics, and mood stabilizers. There is no one medication that treats a personality disorder like BPD, however, a combination of behavioral therapies and medication can help manage symptoms.
Medication for Borderline Personality Disorder
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 final cure for BPD, treatment can significantly reduce symptoms, and typically involves a combination of medication, therapy such as dialectical behavior therapy (DBT) or mentalization-based therapy (MBT), lifestyle changes, and social support.2 There are currently no specific medications that are FDA approved for the treatment of BPD; however, healthcare providers can prescribe certain off-label medications to address symptoms.3
Individuals with BPD are prone to symptoms like anxiety, depression, irritability, and anger or rage.3 When they’re emotionally dysregulated, they may act impulsively. These kinds of impulsive and irritable behaviors include using drugs or alcohol, taking sexual risks, self-harming, or attempting suicide. Antidepressants, mood stabilizers, and antipsychotics are often prescribed to treat these symptoms.
People with BPD may also be prone to anxiety, which can be treated with anti-anxiety and anxiolytic medications. The specific medication(s) recommended for a person with BPD will depend on the symptoms they’re experiencing. Women who are pregnant or nursing may need to avoid or take caution with certain medications.
How to Treat Borderline Personality Disorder
Medications for BPD are most effective in treating BPD when combined with therapy.3 In fact, therapy is considered the first line of treatment for BPD. It teaches skills to cope with distress, regulate emotions, and resolve relationship conflicts. Without therapy, recovery from BPD can be challenging. Additionally, people with BPD can benefit from social support and certain lifestyle changes, like good sleep and diet, to manage their symptoms.
4 Types of BPD Medication for Symptom Relief
Types of BPD medication used to help reduce symptoms include antidepressants, antipsychotics, mood stabilizers/anticonvulsants, and anti-anxiety/anxiolytics.
Here are four types of borderline personality disorder medication used to help alleviate symptoms:
1. Antidepressants
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.
Studies show that certain SSRIs and SNRIs can help manage depression, anxiety, anger, and impulsivity in people with BPD.
Types of SSRI and SNRI antidepressants include:3
- Fluoxetine (Prozac)
- Sertraline (Zoloft)
- Venlafaxine (Effexor)
- Duloxetine (Cymbalta)
- Fluvoxamine (Luvox)
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.
Common side effects of antidepressants are:4
- Gastrointestinal problems like indigestion, pain, nausea, diarrhea, and constipation
- Fatigue
- Dizziness
- Headache
- Low blood pressure
- Blurry vision
- Sweating
- Heat stroke
- Swelling
- Dry mouth
- Low libido
- Weight gain or loss
- Suicidal thoughts
2. Antipsychotics
Antipsychotics are sometimes prescribed to treat psychotic symptoms in people with BPD (e.g., 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 include:3
- Clozapine (Clozaril)
- Risperidone (Risperdal)
- Quetiapine (Seroquel)
- Olanzapine (Zyprexa)
- Ziprasidone (Geodon)
- Paliperidone (Invega)
- Aripiprazole (Abilify)
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 monitor you closely and may prescribe other medications to help prevent or manage side effects.
Common side effects of antipsychotics are:5
- Sedation
- Dizziness
- Headaches
- Low blood pressure
- Weight gain that can result in diabetes
- Dry mouth
- Increased saliva
- Blurry vision
- Changes in movements, such as tremor or stiffness
- Menstrual changes
- Sexual dysfunction
3. Mood Stabilizers/Anticonvulsants
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
- Valproate sodium (Depakote)
- Topiramate (Topimax)
- Lamotrigine (Lamictal)
- Oxcarbazepine (Trileptal)
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
- Gastrointestinal problems like nausea, vomiting, and diarrhea
- Drowsiness
- Dizziness
- Low energy
- Vision changes, such as blurry or double vision
- Tremor
- Weight gain
- Bruising
- Rash
- Hair loss
- Electrolyte imbalance
4. Anti-Anxiety/Anxiolytics
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 medications 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)
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
- Gastrointestinal problems like nausea, vomiting, and diarrhea
- Drowsiness
- Disorientation
- Tremor
- Headache
Current BPD Medications Being Researched
While there aren’t currently any FDA approved drugs for BPD, new medications are currently being studied to determine their efficacy in treating BPD.
Here are three BPD medications that are being researched:
1. Oxytocin
Oxytocin is a chemical naturally found in the body that is involved in many different human behaviors including bonding, labor and breastfeeding. Studies have examined the use of intranasal oxytocin for symptoms of BPD.3 They have found that intranasal oxytocin can help improve empathy and interpersonal functioning.9,10 More research will shed light on whether oxytocin may be a helpful addition to BPD treatment.
2. Brexpiprazole (Rexulti)
Brexpiprazole is a type of antipsychotic called a serotonin-dopamine activity modulator.11 It is currently FDA-approved for the treatment of schizophrenia. One recent study found that it helped improve symptoms of BPD, but the researchers caution that more studies are needed to draw definitive conclusions.12
3. BotulinumToxin (Botox)
Botox is well-known for its anti-aging effects and migraine headache relief, but new research has revealed that it may have emotional benefits as well.11 This medication is injected directly into the skin on the forehead. Emerging research has found that it may help improve mood stability, impulsivity, and negative emotions in people with BPD.13 It has also shown to help with depression.
Finding 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.2Finding 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.
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.
Questions to Ask Your Doctor Before Beginning a New BPD Medication
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 a 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?
Can Borderline Personality Disorder Be Cured?
If you’re wondering whether BPD is curable, understand that it’s a chronic condition, which means people usually experience symptoms throughout their lifetime.15 Periods of stress and instability are likely to increase symptoms; however, with treatment, they’re manageable. Having BPD doesn’t mean you have to suffer forever. Psychotherapy with a BPD specialist, medication, and support from loved ones can help you stabilize symptoms.
