TREATMENT: Medications

[BPDFamily.com]

My SO was on a maintenance dose of Prozac the she told me it had been prescribed for depression.

I discovered some months ago that she had chosen to come off it herself. Strangely enough I had noticed an increase in her irritability and anger about a year ago and I am guessing that was about time she stopped taking it.

I have only recently learned that she most likely surfers from BPD. She is seeing a T but wont speak to me since she started going 5 weeks ago, never mind tell me the diagnosis!

Although knowing what I do now I can still see signs of BPD in her over a year ago I do think that the Prozac probably helped balance her mood swings somewhat.

[Daveh]

My SO was on a maintenance dose of Prozac the she told me it had been prescribed for depression.

I discovered some months ago that she had chosen to come off it herself. Strangely enough I had noticed an increase in her irritability and anger about a year ago and I am guessing that was about time she stopped taking it.

I have only recently learned that she most likely surfers from BPD. She is seeing a T but wont speak to me since she started going 5 weeks ago, never mind tell me the diagnosis!

Although knowing what I do now I can still see signs of BPD in her over a year ago I do think that the Prozac probably helped balance her mood swings somewhat.

[lbjnltx]

From the Clinical Practice Guidelines for the Management of Borderline Personality Disorder, Australian Government National Health and Medical Research Council., 2013

www.nhmrc.gov.au/_files_nhmrc/publications/attachments/mh25_borderline_personality_guideline.pdf

Effects of pharmacotherapy on specific outcomes

Placebo-controlled clinical trials of the following medicines were available for meta-analysis

(Table 5.3 and Section 5.2):

• antidepressant agents including fluvoxaminen (a selective serotonin reuptake inhibitor) and phenelzine (a monoamine oxidase inhibitor)

• anticonvulsant agentso including carbamazepine, valproate,p lamotrigine and topiramate

• antipsychotic agentsq including haloperidol, a first-generation (‘conventional’ or ‘typical’) antipsychotic agent, and the second-generation (‘atypical’) antipsychotic agents aripiprazole, olanzapine and ziprasidone. No studies were identified that evaluated the use of quetiapine in people with BPD.

The findings of the meta-analyses should be interpreted with caution due to the small number of trials for most individual agents and pharmacological classes, and inconsistency between trials for some outcome measures (details in Appendix H). Wide confidence intervals for some studies suggest relatively high variance within those study samples. Included clinical trials do not capture long-term effects of treatment.

Individual agents showed mixed effects on various outcomes compared with placebo, but none showed a consistent, clinically significant benefit across most relevant target outcomes. Overall, aripiprazole achieved the most consistent benefits across several outcome measures, but other agents may be useful in the management of specific symptoms.

Findings of the meta-analyses for specific medicines included the following (versus placebo):

• Among the antidepressant medicines:

–– fluvoxamine (one trial49) was associated with an improvement in BPD symptoms,

but not in anger

–– phenelzine was associated with an improvement in hostility (two trials53, 209), but not in BPD symptoms (two trials53, 209), general psychopathology (two trials53, 209), depression(two trials53, 209), anxiety (one trial53), or general functioning (two trials 53, 209).

• Among the anticonvulsant medicines:

–– carbamazepine (one trial41) was not associated with significant improvements in any of the outcomes included (general psychopathology, hostility, anxiety, depression, general functioning, and interpersonal and social functioning)

–– valproater was associated with significant improvements in irritability (one trial43), depression (two trials42, 43) and in interpersonal and social functioning (one trial42), but not in anger (two trials42, 43), hostility (one trial42), or suicidality (one trial43)

–– lamotrigine was associated with a significant improvement in anger (one trial48) but not BPD symptoms (one trial207)

–– topiramate was associated with a significant improvement in general psychopathology (one trial45), hostility (one trial45), anxiety (one trial45) and in interpersonal and social functioning (one trial45), but not in anger (two trials46, 47) or depression (one trial45).

• Among the antipsychotic medicines:

–– haloperidol was associated with a significant improvement in general functioning two trials53, 208), but a significant worsening of depression (two trials53, 208), and no change in BPD symptoms (two trials53, 208), general psychopathology (two trials53, 208), hostility (two trials53, 208) or anxiety (one trial53)

–– aripiprazole (one trial59) was associated with significant improvements in general psychopathology, anger, hostility, depression, anxiety, and in interpersonal and social functioning

–– olanzapine was associated with improvements in BPD symptoms (two trials55, 57), general psychopathology (two trials55, 57), hostility (one trial57) and irritability (one trial57), and general functioning (two trials55, 57), but not anger (three trials54, 55, 57), depression (one trial54), anxiety (one trial54), suicidality (two trials55, 57) or interpersonal and social functioning (two trials54, 55). Based on pooled data from four trials,54-57 olanzapine was not associated with significantly more weight gain than placebo.

–– ziprasidone (one trial60) was not associated with significant improvements in any  of the included outcomes (BPD symptoms, general psychopathology, anger, hostility, depression, anxiety, or suicidality).

The Committee determined that reliable evidence-based recommendations could not be made about the use of a particular agent to target specific outcomes where fewer than three randomized placebo-controlled clinical trials were available for meta-analysis.

General considerations for the use of pharmacotherapy in BPD

Any pharmacological treatment for a person with BPD should be part of a documented management plan and should be reviewed regularly for therapeutic and adverse effects. When selecting medicines, the prescriber and person with BPD should discuss and agree on specific goals of treatment. Before prescribing any medicine for a person with BPD, prescribers should carefully consider potential interactions with alcohol and other substances, potential drug-to-drug interactions with other prescription and non-prescription medicines, and potential adverse effects in

overdose. People with BPD are at elevated risk of attempted suicide using prescription

medicines210 (e.g. monoamine oxidase inhibitors, tricyclic antidepressant agents, lithium).

Use one medicine at a time and avoid polypharmacy. Review its efficacy and discontinue before trialling another medicine.

If medicines are prescribed to manage acute crisis, the management plan should specify dose and duration of treatment. The length of crises may vary.

Health professionals should explain to people with BPD that medicines only have a limited role in the management of BPD and may have unwanted effects.

BPD is not listed as an approved indication for any medicine licensed in Australia by the Therapeutic Goods Administration, nor is any medicine reimbursed by the Pharmaceutical Benefits Scheme specifically for the treatment of BPD.

[Undine]

I have a mother w/BPD who has sisters that display similar symptoms. They are all on Prozac and say that it has kept them from indulging in the rage episodes. They all seem much happier. They have never been in therapy and it seems to have worked wonders! Yet I have a friend w/BPD on Prozac and it has made absolutely no difference. It is such a frustrating disorder!

[Theo41]

Skip, My uBPDw has the classic behaviors as described in SWOE. At a point, about 15 years ago, she started taking Paxil. The effect was dramatic : my perception was that Paxil restored her to normal. She became the woman I married. Unfortunately, like so many others, she did not like some of the side effects especially weight gain , and ultimately discontinued use. Well, it was nice while it lasted.

[hergestridge]

Short question in addition to my (overlong) post above:

What effect will lithium have on a person that is not bipolar, but is in fact BPD?

My wife has clearly been mis-diagnosed because her doctor is not familiar with her situation. She's not even convinced herself that she is bipolar, she just talked her way to a situation where she could have "better medication", i e a bipolar diagnosis (this out of desperation apparently). Only afterwards does she realize that she may be medicating for something she does not have.

[Googie]

Has anyone had any experience with the new drug Lurasidone (Latuda)?

My daughter started taking it a little over two weeks ago and she just had her first meltdown in months which ended up with having to have her admitted on Wednesday.

I heard there were very few if any side effects so I just wanted to see what any of you might have to say.

Googie

Lurasidone (Latuda)

Prescription drug

Consult a doctor if you have a medical concern.

Treats schizophrenia and BiPolar disorder

Side effects - Warnings - How to use

National Library of Medicine

Brand name: Latuda

Pregnancy risk: Category B (No evidence of risk in humans)

Drug class: Atypical antipsychotic

Other drugs in same class: Aripiprazole, Asenapine, Quetiapine, More

[pessim-optimist]

It appears that is is not a brand new drug (we have a mention of it here from 2011):

https://bpdfamily.com/message_board/index.php?topic=145158.msg1415932#msg1415932

So hopefully some members may have some real-life reports about it...  

NAMI has a description of it from the College of Psychiatric and Neurologic Pharmacists from January 2013:

www.nami.org/Template.cfm?Section=About_Medications&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=51&ContentID=119465

Another site quotes that there is only minimal risk of weight-gain as a side-effect (that's a plus!)

[ncmoms]

I know I'm posting in an old thread, but wanted to relay my experiences.

My DD has been on this medication roller coaster for about 2 years now, starting with Zoloft for depression, a number of anti-anxiety meds, Welbutrin, Abilify, Lexapro, lithium, and most recently Saphris.  Of all these, the Abilify was the first to show any sign of positive change in her, helping her to at least stabilize emotionally somewhat.  She still had depression, anxiety and  self harm tendencies but not as frantically.   After a suicide attempt a year ago, the hospital decided to take her off all the antidepressants and start lithium.  After about 3 weeks she was a completely different person with very few signs of the depression and anxiety.  The problem was the weight gain, and so the doctor switched her to Saphris.  Although she still exhibits all the classic signs of BPD, her suicidal ideation and self harm are almost completely gone. 

[nomoreoptions]

My 18yo DS has been diagnosed with PTSD, mood disorder, ADHD, and BPD.  BPD was the most recent.  Prozac is commonly used to treat PTSD, and we see a remarkable improvement in just about all areas but not until he reaches a dosage of 60 mg.  Recently his dosage was decreased to 40 mg and all hell broke loose.  Back at 60 and things are much better, it is clear that it helps him manage his BPD as well.  BUT at 60 he felt flat, so 150 mg of Wellbutrin was added, which did the trick and gave him back his energy.  He also takes 20 mg of Ritalin LA, which has been a godsend and has reduced his school-related rage.  As noted, there seems to be at least some relationship between ADHD, executive functioning and BPD.  His neuropsych tests showed that, despite normal IQ, his working memory was in the FIRST percentile, I can't even imagine how frustrating that must be, I'd rage too with those kinds of challenges.  Just recently he has been prescribed a low dose of Abilify, as some triggers have made his BPD more obvious and his therapist believes it's time and he's ready to start coming to terms with the trauma he experienced with his birth mother.  Aerobic exercise helps, when he does it.

So...  this process alone, of figuring out dosages/diagnoses while having weekly therapy sessions, has taken a year and a half.  So far his team feels that individual therapy is best for him, and I see improvement both from therapy and meds, but this is no short-term process.

[maxen]

my BPDw takes clonazepam and seroquel, but not for BPD, which can't be medicated in itself and which so far as i know no-one has mentioned to her anyway. and whatever these medications have done they haven't touched her BPD traits.

[maxsterling]

Just saw this thread -

My GF has been put on Latuda.  She's also on Lithium and Wellbutrin. 

The Dr started her on Latuda because of potential side effects with other mood stabilizers - birth defects if she got pregnant (supposedly Latuda is safer) and weight gain.  I also seem to remember another mood stabilizer she was on was also causing restless leg syndrome, so they switched to Latuda.

I can't really say anything positive or negative.  Her rages have been less violent since she went on medication, but that could be the Lithium, or could just be her being more accepting of her situation.  But, there haven't been any negative changes.  Personally, I haven't seen enough positive change to say the mood stabilizing drugs are doing any good.  The Wellbutrin seems to have helped some, but she is far from being happy.  She was also diagnosed Bipolar - and the meds should help her with that.  But since there hasn't been much of a change, I'm thinking she isn't bipolar at all - just really bad BPD.

[Googie]

Maxsterling- My DD16 is bipolar as well.  Latuda was discontinued due to the fact her med (trileptal) was working just fine, my dd just wanted to control her own care and the doc was willing to change things up without knowing her med hx. 

She has recently convinced her doc to half the trileptal and has since started down the all too predictable slippery slope.  Her treatment team thinks she is fine, but I see big trouble right around the corner.  Going to post about it and hope to hear some great advice from you guys.

Googie

[TommyBahama]

Good day, I was just wondering if there was any medicine or vitamins that have been shown to work for people with BPD?  Fr example my son has ADHD and when he is on his medicine he behaves himself and can focus in school.  My wife had BPD and I am wondering if anything has been developed in terms of medicine or is science still learning a lot about BPD and how it works?