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Borderline Personality Disorder Medication: Types, Side Effects, & Management

Published: February 15, 2022 Updated: October 27, 2022
Published: 02/15/2022 Updated: 10/27/2022
Headshot of Emily Guarnotta, PsyD
Written by:

Emily Guarnotta

PsyD
Headshot of Dr. Kristen Fuller, MD
Reviewed by:

Kristen Fuller

MD
  • Medication for Borderline Personality DisorderMedication for BPD
  • How to Treat Borderline Personality DisorderTreatment
  • Types of BPD Medication for Symptom ReliefTypes
  • Current BPD Medications Being ResearchedCurrent Research
  • Finding the “Best” Medication For BPDBest BPD Meds
  • Questions to Ask Your Doctor Before Beginning a New BPD MedicationQuestions to Ask
  • Can Borderline Personality Disorder Be Cured?Is BPD Curable?
  • Additional ResourcesResources
Headshot of Emily Guarnotta, PsyD
Written by:

Emily Guarnotta

PsyD
Headshot of Dr. Kristen Fuller, MD
Reviewed by:

Kristen Fuller

MD

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.

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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

Help For BPD

Talk Therapy – Get help living with Borderline Personality Disorder from a licensed therapist. Betterhelp offers online therapy starting at $60 per week. Get matched With A Therapist


Virtual Psychiatry – Get help from a real doctor that takes your insurance. Talkiatry offers medication management and online visits with top-rated psychiatrists. Take the online assessment and have your first appointment within a week. Free Assessment


DBT Skills Course – DBT is a popular treatment for BPD. Learn DBT skills with live weekly classes and online video courses. Free Trial

Choosing Therapy partners with leading mental health companies and is compensated for marketing by BetterHelp, Talkiatry, and Jones Mindful Living.

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:

  1. How should I take this medication?
  2. How will I know if it’s working?
  3. What side effects are common with this medication?
  4. What should I do if I experience side effects?
  5. Are there any other risks?
  6. Are there any foods, supplements, or other medications that I should avoid?
  7. 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.

Additional Resources

Education is just the first step on our path to improved mental health and emotional wellness. To help our readers take the next step in their journey, Choosing Therapy has partnered with leaders in mental health and wellness. Choosing Therapy may be compensated for marketing by the companies mentioned below.

Virtual Psychiatry

Talkiatry – Get help from a real doctor that takes your insurance. Talkiatry offers medication management and online visits with top-rated psychiatrists. Take the online assessment and have your first appointment within a week. Free Assessment

Hims / Hers – If you’re living with anxiety or depression, finding the right medication match may make all the difference. Get FDA approved medication prescribed by your dedicated Hims / Hers Healthcare Provider and delivered right to your door. Plans start at $25 per month (first month). Get Started

Medication + Therapy

Brightside Health – Together, medication and therapy can help you feel like yourself, faster. Brightside Health treatment plans start at $95 per month. United Healthcare, Anthem, Cigna, and Aetna accepted. Following a free online evaluation and receiving a prescription, you can get FDA approved medications delivered to your door. Free Assessment

Choosing Therapy partners with leading mental health companies and is compensated for marketing by Brightside, Hims / Hers, and  Talkiatry.

For Further Reading

  • National Institute of Mental Health (NIH)
  • National Education Alliance for Borderline Personality Disorder
  • American Psychiatric Association (APA)
  • Books About Living with Borderline Personality Disorder
15 sources

Choosing Therapy strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy.

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA.

  • Leichsenring, F., Leibing, E., Kruse, J., New, A. S., & Leweke, F. (2011). Borderline personality disorder. The Lancet, 377(9759), 74-84. https://pubmed.ncbi.nlm.nih.gov/21195251/

  • Bozzatello, P., Rocca, P., De Rosa, M. L., & Bellino, S. (2020). Current and emerging medications for borderline personality disorder: Is pharmacotherapy alone enough?. Expert Opinion on Pharmacotherapy, 21(1), 47-61. https://pubmed.ncbi.nlm.nih.gov/31693423/

  • Ramic, E., Prasko, S., Gavran, L., & Spahic, E. (2020). Assessment of the antidepressant side effects occurrence in patients treated in primary care. Materia Socio-Medica, 32(2), 131–134. https://pubmed.ncbi.nlm.nih.gov/32843862/

  • Stroup, T. S., & Gray, N. (2018). Management of common adverse effects of antipsychotic medications. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 17(3), 341–356. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6127750/

  • Nath, M., & Gupta, V. (2021). Mood stabilizers. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK556141/

  • Guina, J., & Merrill, B. (2018). Benzodiazepines I: upping the care on downers: The evidence of risks, benefits and alternatives. Journal of Clinical Medicine, 7(2), 17. https://pubmed.ncbi.nlm.nih.gov/29385731/

  • Bounds, C. G., & Nelson, V. L. (2020). Benzodiazepines. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK470159/

  • Domes, G., Ower, N., von Dawans, B., Spengler, F. B., Dziobek, I., Bohus, M., … & Heinrichs, M. (2019). Effects of intranasal oxytocin administration on empathy and approach motivation in women with borderline personality disorder: A randomized controlled trial. Translational Psychiatry, 9(1), 1-9. https://www.nature.com/articles/s41398-019-0658-4

  • Schneider, I., Boll, S., Volman, I., Roelofs, K., Spohn, A., Herpertz, S. C., & Bertsch, K. (2020). Oxytocin normalizes approach–Avoidance behavior in women with borderline personality disorder. Frontiers in Psychiatry, 11, 120. https://www.frontiersin.org/articles/10.3389/fpsyt.2020.00120/full

  • Stoffers-Winterling, J., Storebø, O. J., & Lieb, K. (2020). Pharmacotherapy for borderline personality disorder: An update of published, unpublished and ongoing studies. Current Psychiatry Reports, 22, 1-10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7275094/

  • Grant, J. E., Valle, S., Chesivoir, E., Ehsan, D., & Chamberlain, S. R. (2021). A double-blind placebo-controlled study of brexpiprazole for the treatment of borderline personality disorder. The British Journal of Psychiatry, 1-6. https://pubmed.ncbi.nlm.nih.gov/35049469/

  • Kim, J., Khoury, R., & Grossberg, G. T. (2018). Botulinum toxin: Emerging psychiatric indications: Botulinum toxin has shown promising antidepressant effects, and might be helpful for several other indications. Current Psychiatry, 17(12), 8-19. https://www.mdedge.com/psychiatry/article/189837/depression/botulinum-toxin-emerging-psychiatric-indications

  • Millon, T., Grossman, S., Millon, C., Meagher, S., & Ramnath, R. (2004). Personality disorders in modern life. Hoboken, NJ: John Wiley & Sons.

  • Biskin R. S. (2015). The lifetime course of borderline personality disorder. Canadian Journal of Psychiatry, 60(7), 303–308. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4500179/

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PsyD
Headshot of Dr. Kristen Fuller, MD
Reviewed by:

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  • Medication for Borderline Personality DisorderMedication for BPD
  • How to Treat Borderline Personality DisorderTreatment
  • Types of BPD Medication for Symptom ReliefTypes
  • Current BPD Medications Being ResearchedCurrent Research
  • Finding the “Best” Medication For BPDBest BPD Meds
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  • Additional ResourcesResources
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Privacy & Cookies Policy

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