TREATMENT: Medications

[BPDFamily.com]

My dBPDm was put on this a few weeks ago.  She is strangely happy almost to the point of being inappropriate.  Her affect is weird.  She is giddy.  She has also been falling a lot.  

It is almost like a weird type of mania.  Still making terrible financial decisions, but that no longer is my worry.  

ABILIFY

Schizophrenia  ABILIFY is indicated for the treatment of schizophrenia. The efficacy of ABILIFY was established in four 4-6 week trials in adults and one 6-week trial in adolescents (13 to 17 years). Maintenance efficacy was demonstrated in one trial in adults and can be extrapolated to adolescents [see Clinical Studies].

Bipolar I Disorder

Monotherapy

ABILIFY is indicated for the acute and maintenance treatment of manic and mixed episodes associated with bipolar I disorder. Efficacy was established in four 3-week monotherapy trials in adults and one 4-week monotherapy trial in pediatric patients (10 to 17 years). Maintenance efficacy was demonstrated in a monotherapy trial in adults and can be extrapolated to pediatric patients (10 to 17 years) [see Clinical Studies].

Adjunctive Therapy

ABILIFY is indicated as an adjunctive therapy to either lithium or valproate for the acute treatment of manic and mixed episodes associated with bipolar I disorder. Efficacy was established in one 6-week adjunctive trial in adults and can be extrapolated to pediatric patients (10 to 17 years) [see Clinical Studies].

Adjunctive Treatment of Major Depressive Disorder

ABILIFY is indicated for use as an adjunctive therapy to antidepressants for the treatment of major depressive disorder (MDD). Efficacy was established in two 6-week trials in adults with MDD who had an inadequate response to antidepressant therapy during the current episode [see Clinical Studies].

Irritability Associated with Autistic Disorder

ABILIFY is indicated for the treatment of irritability associated with autistic disorder. Efficacy was established in two 8-week trials in pediatric patients (aged 6 to 17 years) with irritability associated with autistic disorder (including symptoms of aggression towards others, deliberate self-injuriousness, temper tantrums, and quickly changing moods) [see Clinical Studies].

Agitation Associated with Schizophrenia or Bipolar I Mania

ABILIFY Injection is indicated for the acute treatment of agitation associated with schizophrenia or bipolar disorder, manic or mixed. "Psychomotor agitation" is defined in DSM-IV as "excessive motor activity associated with a feeling of inner tension". Patients experiencing agitation often manifest behaviors that interfere with their diagnosis and care (eg, threatening behaviors, escalating or urgently distressing behavior, or self-exhausting behavior), leading clinicians to the use of intramuscular antipsychotic medications to achieve immediate control of the agitation. Efficacy was established in three short-term (24-hour) trials in adults [see Clinical Studies].

Special Considerations in Treating Pediatric Schizophrenia, Bipolar I Disorder, and Irritability Associated with Autistic Disorder

Psychiatric disorders in children and adolescents are often serious mental disorders with variable symptom profiles that are not always congruent with adult diagnostic criteria. It is recommended that psychotropic medication therapy for pediatric patients only be initiated after a thorough diagnostic evaluation has been conducted and careful consideration given to the risks associated with medication treatment. Medication treatment for pediatric patients with schizophrenia, bipolar I disorder, and irritability associated with autistic disorder is indicated as part of a total treatment program that often includes psychological, educational, and social interventions.

[nichole79]

My dBPDm was put on this a few weeks ago.  She is strangely happy almost to the point of being inappropriate.  Her affect is weird.  She is giddy.  She has also been falling a lot.  

It is almost like a weird type of mania.  Still making terrible financial decisions, but that no longer is my worry.  

ABILIFY

Schizophrenia  ABILIFY is indicated for the treatment of schizophrenia. The efficacy of ABILIFY was established in four 4-6 week trials in adults and one 6-week trial in adolescents (13 to 17 years). Maintenance efficacy was demonstrated in one trial in adults and can be extrapolated to adolescents [see Clinical Studies].

Bipolar I Disorder

Monotherapy

ABILIFY is indicated for the acute and maintenance treatment of manic and mixed episodes associated with bipolar I disorder. Efficacy was established in four 3-week monotherapy trials in adults and one 4-week monotherapy trial in pediatric patients (10 to 17 years). Maintenance efficacy was demonstrated in a monotherapy trial in adults and can be extrapolated to pediatric patients (10 to 17 years) [see Clinical Studies].

Adjunctive Therapy

ABILIFY is indicated as an adjunctive therapy to either lithium or valproate for the acute treatment of manic and mixed episodes associated with bipolar I disorder. Efficacy was established in one 6-week adjunctive trial in adults and can be extrapolated to pediatric patients (10 to 17 years) [see Clinical Studies].

Adjunctive Treatment of Major Depressive Disorder

ABILIFY is indicated for use as an adjunctive therapy to antidepressants for the treatment of major depressive disorder (MDD). Efficacy was established in two 6-week trials in adults with MDD who had an inadequate response to antidepressant therapy during the current episode [see Clinical Studies].

Irritability Associated with Autistic Disorder

ABILIFY is indicated for the treatment of irritability associated with autistic disorder. Efficacy was established in two 8-week trials in pediatric patients (aged 6 to 17 years) with irritability associated with autistic disorder (including symptoms of aggression towards others, deliberate self-injuriousness, temper tantrums, and quickly changing moods) [see Clinical Studies].

Agitation Associated with Schizophrenia or Bipolar I Mania

ABILIFY Injection is indicated for the acute treatment of agitation associated with schizophrenia or bipolar disorder, manic or mixed. "Psychomotor agitation" is defined in DSM-IV as "excessive motor activity associated with a feeling of inner tension". Patients experiencing agitation often manifest behaviors that interfere with their diagnosis and care (eg, threatening behaviors, escalating or urgently distressing behavior, or self-exhausting behavior), leading clinicians to the use of intramuscular antipsychotic medications to achieve immediate control of the agitation. Efficacy was established in three short-term (24-hour) trials in adults [see Clinical Studies].

Special Considerations in Treating Pediatric Schizophrenia, Bipolar I Disorder, and Irritability Associated with Autistic Disorder

Psychiatric disorders in children and adolescents are often serious mental disorders with variable symptom profiles that are not always congruent with adult diagnostic criteria. It is recommended that psychotropic medication therapy for pediatric patients only be initiated after a thorough diagnostic evaluation has been conducted and careful consideration given to the risks associated with medication treatment. Medication treatment for pediatric patients with schizophrenia, bipolar I disorder, and irritability associated with autistic disorder is indicated as part of a total treatment program that often includes psychological, educational, and social interventions.

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[Silver08]

My uBPD mom also has depression and was given Abilify about a year ago.  She reacted the same way.  It was over the top, but better than the alternative.  It was very short lived though.  I'm not sure if she went off of it or if the initial effects wore off.

[UKannie]

My dBPDm was put on this a few weeks ago.  She is strangely happy almost to the point of being inappropriate.  Her affect is weird.  She is giddy.  She has also been falling a lot. 

It is almost like a weird type of mania.  Still making terrible financial decisions, but that no longer is my worry. 

I'm not a medical doctor but those sound like the kind of side effects that the physician who supplied them to her should know about. I am not BPD but I reacted to a completely different psychoactive drug once in a similar way as my system would not tolerate the drug. Staying on it longer made me more and more ill.

I don't want to alarm you - but I think a doctor should be made aware of unwanted side effects. He/she may see them as temporary, and view that they will pass, but they should still know. Maybe you could write and let them know. I know there are confidentiality issues (ie they will not tell you whether they plan to change her treatment or disclose anything about her condition) but at least you will feel you've done something constructive. Or you could write down the changes you've seen in your mother since the meds on a piece of paper and ask her to read it out to her doctor. That way, she gets to take responsibility.

I know drawing boundaries with BPD parents is hard, so I don't want dictate what anyone should do, or where their responsibilities lie. Also note: I am coming at this from a perspective of experiencing the UK health system where you sometimes have to be very demanding and very informed to get the level of treatment you need. My parents are both mentally ill, and even though their behaviour has been abusive and neglectful in the past, I feel very protective of them (and angry on their behalf) when I feel they are not getting the medical care they need.

I think though, the fact that you have posted on this board shows you are very worried. Maybe if you 'hand the problem over' to a health professional you will feel you have 'done your bit' and can rest easier.

I don't want to preach so please feel free to ignore this... .

Annie

[O'Maria]

Is medication enough to treat the aggressive behavior/acting out? Many posts indicate that BPDs have too much emotions. Looks like we all liked the "good" loving behavior and dislike the "bad" negative emotions.

My ex was put on anti-anxiety drugs and got much better for a while. It helped him focus and reflect over his actions and it certainly calmed him down. He stopped taking the pills and then the raging and mood swings started again.

[Auspicious]

Is medication enough to treat the aggressive behavior/acting out?

The general consensus in the psychiatric world seems to be that medication alone is not enough for treating BPD.

[ccb1991]

Has anybody ever tried or heard of lithium carbonate for BPD?  I was just reading about it being used for impulsive behavior and rash judgements.

[Vivgood]

Back when I was in-patient (and that's a good 35 years, kiddies ), lithium carbonate was the drug of choice for bipolar, called manic-depression then. There's a lot of overlap between BPD and Bipolar. Its a HARD drug. very ugly side effects, and I remember the people on lithium all had "the walkies", where they rock from side-to-side or sort of march inplace because they couldn't be still. Also they tended to get a flat effect (little facial expression). However... .as is often the case with psychotropic meds, for SOME people, lithium was a godsend. Oh, and I remember a doc telling me that lithium was the definitive test for wether or not a patient had bipolar- if you give them lithium and they get better, then your dx was right... .if you gave them lithium and it made them worse, you dx'd wrong. That same sort of philosophy is still in play, tho less specifically. reassuring, no?

There are new gen drugs that usually are preferred over lithium, these days.

vivgood

[tiredmommy2]

Hi ccb,

My BPDd was on Lithium for a while.  At first, it seemed to help, but she was back to her normal self (out of control) in a few weeks.  There is no drug that can help my d right now - she's too determined not to get well. 

Vivgood is right - there are newer drugs that doctors like to try first, but Lithium can be used when all else fails.  People taking it can experience some pretty nasty side effects.  In addition, routine lab work must be done to make sure the Lithium level is therapeutic.  If the level is too low, it doesn't work... .A high level can lead to toxicity. 

[serenitygone]

Latuda(antipsychotic & schizo) and Stelazine(antipsychotic/schizo) used for anxiety

The latuda has really made a difference.  We tried Sapphris but the taste was making her puke.

Latude is new.  Stelazine is a try before we go to Thorazine(which they're holding out for obvious reasons)

[Auspicious]

Two antipsychotics is risky ... watch out for Neuroleptic Malignant Syndrome
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3726098/

Presumably the psychiatrist is watching out for this ... just keep an eye out.

[jsdun5]

I think it really depends on the individual and how the disorder manifests itself. For example, I've read that Seroquel (Quetiopine) is effective for helping balance out mood from some BPD sufferers but with everything it is about what works for that person. There is no right or wrong answer. There isn't a specific medication designed to deal with BPD like there is depression or anxiety but both these types of meds can be used to alleviate some of the symptoms of or problems caused by BPD. I personally tried many different meds until I knew what was right for me.

I hope this was helpful.

[jumanti]

my BPD partner is on moclobomide150mg 2 twice a day, carbamazapine 400mg 1 twice a day and quetiepine 100mg 1 five times a day but after a recent breakdown episode which had been slowly building for months with bad mood swings Jekyll and hyde behaviour his psychiatrist is now thinking of introducing lithium ( jsut awaiting blood results) and gradually reducing the carbamazapine just hoping the lithium will help stabalize his moods as they are real bad at the moment but he dosen't recognize it himself he has to be told they are. but at the time he wont admit it telling him just makes him worse, but when he sees his psychiatrist he will tell him 'my wife has told me my moods are bad but i dont realize they are' fingers crossed for lithium

[mggt]

Hi,

I was wondering if anyone had any exp with medications called Phenelzine (phenelzine nardil) for BPD dont know much about it at all but was reading some information on line and reviews were good for depression and other types of illness.  Has there been any studies done on this drug for BPD and it guess this is a older drug and it is not used to quickly ,again i don't know much about it so be aware.

[connect]

Mine is on them for depression and I wondered if they help with BPD. He is coming off them at the moment and his BPD is geting worse.

Thanks

[Mischeevious]

Mine has been on anti-depressants for years, I certainly notice the difference if he decides to stop for a few days ( in the narcissistic phase when he thinks there's nothing wrong with him) I wouldn't say they've improve the BPD they just stop him from being quite as volatile.

[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.

[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

[pessim-optimist]

It appears that is is not a brand new drug, Latuda (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:
https://www.nami.org/Learn-More/Treatment/Mental-Health-Medications/lurasidone-(Latuda)

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

[HappyNihilist]

I take Paxil for panic disorder and depression, and I've been on it for over 10 years. (Dosage is usually upped every 4 years or so.)

For the first few months, I had zero libido and couldn't achieve orgasm, but fortunately those side effects went away after about month 6 in my case. The only side effects that have lasted are occasional night sweats and the weird "brain zaps" that happen if I miss a day's dosage. (Yes, Paxil has seriously heinous withdrawal symptoms.)

I've tried other meds, but they didn't work on my anxiety and depression like Paxil. Just the nature of my body chemistry, I guess. Everyone's wired a little differently.

So, I definitely think it's worth a try for someone struggling with anxiety and/or depression. Watch for the side effects, because if they last, then I'm not sure the tradeoff is worth it. And before anyone starts on Paxil or a similar SSRI, they should be aware of just how difficult the withdrawal is -- and if they want to stop it once they've started, they will need to do so under the supervision of a doctor. It's not good to just stop an SSRI cold turkey.

[Momofadultbpd]

I’m am feeling great ever since my ex and I are using Dr Frizzettis Validating techniques. It has made a huge difference in how we all interact.

And the 3 Ketalar (ketamine) treatments have gone very well and my daughter has not mentioned suicide once she she started the ketamine despite a big blow up one day with her sister.

She has one more week of ketamine and then she starts a 5 week DBT program.

I am extremely optimistic that we have finally found a great way to manage her condition—ketamine and DBT.

Fingers crossed. It’s still early. But this is the first hope I have had in 15 years.

MomofadultBPD

[Cat Familiar]

When the doctor put my mom on Paxil, it was like having a completely different mom. It seemed to take effect far more quickly than what I had expected. About a week after she began the meds, I went over to her house and she was SINGING!

I hadn't heard her sing since I was a child. She was far happier and much less agitated, until the dementia increased.

[AskingWhy]

My uBPD H was put on Zoloft for about a year when he was misdiagnosed with PTSD.  This is a common misdiagnosis because BPD is seen as a "women's illness."  He went off the Zoloft after a year.