Dodgy Prescriptions: Borderline Personality Disorder and Medication
The best medicine doesn’t come on a prescription sheet. However, there are drugs that help treat specific symptoms.
Mood Stabilisers: Originally created for the treatment of epilepsy and other seizure related disorders, anticonvulsants were quickly recognised as potential drugs to regulate mood. After all, there is a symptom overlap: Paroxysms of rage or sadness, and paroxysms full stop are similar, and the same areas of the brain are implicated too . Mood stabilisers, are thought to calm excitable neurons in the cerebrum, and dampen the hyperactivity of the nervous system. This means outbursts of all kinds will decrease. Below are the most common one’s used in the treatment of BPD.
Lamotrigine: Lamotrigine has shown evidence of decreasing impulsivity in Borderline Personality Disorder. Well tolerated but unfortunately this medicine contains a ‘black box’ warning, due to its potential life threatening skin reaction
Valproate: There is some evidence Valproate works in reducing aggression, and can also lift mood, but the data available is inconsistent. An old-fashioned drug with limited usage for BPD.
Carbamazepine: It is commonly believed that carbamazepine has specific anti-aggressive properties. However, there is no clear evidence that it works with BPD, and its interactions with other drugs means its best avoided.
Topiramate: There is evidence that Topiramate helps with anger, anxiety, & depression. However, it has a long list of side effects; the most problematic being excessive sleepiness and poor concentration.
Antipsychotics — a scary title, but many antipsychotics are prescribed for other conditions beside schizophrenia or Bipolar. They work by blocking dopamine pathways in the brain. While we know excess dopamine can increase the chances of psychosis, we also know it can increase the chances of other mental health conditions including OCD, ADHD and addiction. These are just labels, but we know BPD has an overlap with psychosis especially in cognition; for example dissociation and paranoia. Meanwhile behaviours like self-harm can resememble an addiction, this means antipsychotics can have benefits. Below are a list of the most common
Haloperidol: A heavy duty old fashioned drug, which reduces anger, hostility, and impulsivity. Unfortunately major side effects include massive weight gain and sleepiness
Olanzapine: A 2nd generation antipsychotic, Olanzapine It may help with dissociation or paranoia in BPD but evidence is limited. The main drawback is weight gain.
Aripiprazole: Another 2nd generation antipsychotic used to treat Schizophrenia there is some evidence that it can also lift mood and ease depression, but evidence is again limited.
Antidepressants: The common theory behind mental illness, is that there is a chemical imbalance in the brain — specifically serotonin. A lack of serotonin causes a litany of symptoms which affect everything from sleep and digestion to mood and stress. Antidepressants, work by stopping serotonin from being reabsorbed into a cell before it’s finished its job. Hence Selective Serotonin Reuptake Inhibitors help chemicals linger in the brain for longer. Using antidepressants for a personality disorder doesn’t work, but as an auxiliary way to help regulate mood, that can be beneficial
fluoxetine: Everyone’s on prozac these days, but its proliferation is not necessarily good. Prozac can ease depression & anxiety in BPD, but improvements are modest to say the least.
Fluvoxamine: Used primarily in the treatment of MDD, OCD PTSD & anxiety, Fluvoxamine is a very potent SSRI. It has some evidence that it diminishes anxiety in individuals with BPD.
At this stage it may feel pretty hopeless. Perhaps you were looking for a cure, or at least something to take the edge off. On the other hand, you may be more cheerful knowing medication was never right for you. Different people require different solutions, however, when it comes to pharmacological treatment of borderline personality disorder, the fact remains evidence is scant. Drugs may target specific symptoms, but not the diagnosis overall. In fact there are currently know licensed medications used in the treatment of BPD, and the consensus is that they don’t work.
Thats the way it should be: After all the personality is as rich and complex thing. That we could be reduced to chemical reactions is rather disappointing. Recovery is a long road out of hell, and we have to be willing to take the journey if we have a chance of getting better. When it comes to medication, be your own advocate, don’t let yourself be harassed into taking drugs which you don’t think will work; meanwhile don’t let yourself misled by those who are resolutely anti-medication full stop. Arm yourself with knowledge, self-respect, and self-reliance, and in time you’ll recognise you yourself can be your own doctor and have the best prognosis possible.