TREATMENT: Medications

[BPDFamily.com]

Updated: December 2017National Institute of Mental Health
A brief overview that focuses on the symptoms, treatments, and research findings.
https://bit.ly/2dXGG2V

Borderline personality disorder is a mental illness marked by an ongoing pattern of varying moods, self-image, and behavior. These symptoms often result in impulsive actions and problems in relationships. People with borderline personality disorder may experience intense episodes of anger, depression, and anxiety that can last from a few hours to days.

Treatment

Borderline personality disorder has historically been viewed as difficult to treat. But, with newer, evidence-based treatment, many people with the disorder experience fewer or less severe symptoms, and an improved quality of life. It is important that people with borderline personality disorder receive evidence-based, specialized treatment from an appropriately trained provider. Other types of treatment, or treatment provided by a doctor or therapist who is not appropriately trained, may not benefit the person.

Many factors affect the length of time it takes for symptoms to improve once treatment begins, so it is important for people with borderline personality disorder and their loved ones to be patient and to receive appropriate support during treatment.

Psychotherapy

Psychotherapy is the first-line treatment for people with borderline personality disorder. A therapist can provide one-on-one treatment between the therapist and patient, or treatment in a group setting. Therapist-led group sessions may help teach people with borderline personality disorder how to interact with others and how to effectively express themselves.

It is important that people in therapy get along with, and trust their therapist. The very nature of borderline personality disorder can make it difficult for people with the disorder to maintain a comfortable and trusting bond with their therapist.

Two examples of psychotherapies used to treat borderline personality disorder include:

• Dialectical Behavior Therapy (DBT): This type of therapy was developed for individuals with borderline personality disorder. DBT uses concepts of mindfulness and acceptance or being aware of and attentive to the current situation and emotional state. DBT also teaches skills that can help:
          Control intense emotions
          Reduce self-destructive behaviors
          Improve relationships

   

• Cognitive Behavioral Therapy (CBT): This type of therapy can help people with borderline personality disorder identify and change core beliefs and behaviors that underlie inaccurate perceptions of themselves and others, and problems interacting with others. CBT may help reduce a range of mood and anxiety symptoms and reduce the number of suicidal or self-harming behaviors.

Medications

Because the benefits are unclear, medications are not typically used as the primary treatment for borderline personality disorder. However, in some cases, a psychiatrist may recommend medications to treat specific symptoms such as:

    mood swings
    depression
    other co-occurring mental disorders

Treatment with medications may require care from more than one medical professional.

Certain medications can cause different side effects in different people. Talk to your doctor about what to expect from a particular medication. Read more in NIMH’s Mental Health Medications health topic.

[Skippy]

Updated: December 2017National Institute of Mental Health
A brief overview that focuses on the symptoms, treatments, and research findings.
https://bit.ly/2dXGG2V

Borderline personality disorder is a mental illness marked by an ongoing pattern of varying moods, self-image, and behavior. These symptoms often result in impulsive actions and problems in relationships. People with borderline personality disorder may experience intense episodes of anger, depression, and anxiety that can last from a few hours to days.

Treatment

Borderline personality disorder has historically been viewed as difficult to treat. But, with newer, evidence-based treatment, many people with the disorder experience fewer or less severe symptoms, and an improved quality of life. It is important that people with borderline personality disorder receive evidence-based, specialized treatment from an appropriately trained provider. Other types of treatment, or treatment provided by a doctor or therapist who is not appropriately trained, may not benefit the person.

Many factors affect the length of time it takes for symptoms to improve once treatment begins, so it is important for people with borderline personality disorder and their loved ones to be patient and to receive appropriate support during treatment.

Psychotherapy

Psychotherapy is the first-line treatment for people with borderline personality disorder. A therapist can provide one-on-one treatment between the therapist and patient, or treatment in a group setting. Therapist-led group sessions may help teach people with borderline personality disorder how to interact with others and how to effectively express themselves.

It is important that people in therapy get along with, and trust their therapist. The very nature of borderline personality disorder can make it difficult for people with the disorder to maintain a comfortable and trusting bond with their therapist.

Two examples of psychotherapies used to treat borderline personality disorder include:

• Dialectical Behavior Therapy (DBT): This type of therapy was developed for individuals with borderline personality disorder. DBT uses concepts of mindfulness and acceptance or being aware of and attentive to the current situation and emotional state. DBT also teaches skills that can help:
          Control intense emotions
          Reduce self-destructive behaviors
          Improve relationships

   

• Cognitive Behavioral Therapy (CBT): This type of therapy can help people with borderline personality disorder identify and change core beliefs and behaviors that underlie inaccurate perceptions of themselves and others, and problems interacting with others. CBT may help reduce a range of mood and anxiety symptoms and reduce the number of suicidal or self-harming behaviors.

Medications

Because the benefits are unclear, medications are not typically used as the primary treatment for borderline personality disorder. However, in some cases, a psychiatrist may recommend medications to treat specific symptoms such as:

    mood swings
    depression
    other co-occurring mental disorders

Treatment with medications may require care from more than one medical professional.

Certain medications can cause different side effects in different people. Talk to your doctor about what to expect from a particular medication. Read more in NIMH’s Mental Health Medications health topic.

[GENERAL ANNOUNCEMENT]

GENERAL ANNOUNCEMENT This board is intended for general questions about BPD and other personality disorders, trait definitions, and related therapies and diagnostics. Topics should be formatted as a question. Please do not host topics related to the specific pwBPD in your life - those discussions should be hosted on an appropraite [L1] - [L4] board. You will find indepth information provided by our senior members in our workshop board discussions (click here).

[Skippy]

Updated: March 2019Medications Studied and Used in the Treatment of Borderline Disorder+
Robert O. Fiedel, MD
https://bit.ly/2XKNCHa

Antipsychotic Agents

This is one of most useful classes of medications for the treatment of patients with borderline disorder.27 They are most commonly used to treat other mental illnesses, especially bipolar disorder and schizophrenia. However, when prescribed at lower doses than used for these two disorders, these agents also have been found to be quite useful in the treatment of many patients with borderline disorder. This class of medications is the most rational starting point for pharmacotherapy in patients with borderline disorder who have cognitive-perceptual symptoms such as a suspiciousness, paranoia, split (all-or-nothing) thinking, and dissociative episodes. The size of these therapeutic effects are often moderate to large. Studies suggest that Abilify has the largest effect size in this class, and that the effects are sustained over an extended period of time.29

If one or more cognitive-perceptual symptoms are present and respond well to an antipsychotic agent, but other symptoms such as impulsivity and poor emotional control persist, the addition of another medication from the class of mood stabilizers discussed below is indicated.

Special Notes: Some patients are concerned about taking a medication that is typically used for people with severe mental illnesses. Also, some physicians are reluctant to prescribe this class of medications because of a specific side effect that they may produce called tardive dyskinesia. This is an abnormal, involuntary movement disorder that occurs in patients typically receiving average to large doses of these agents.

To my knowledge, there is no scientific evidence that indicates these medications, as typically used in patients with borderline disorder, cause tardive dyskinesia. Nonetheless, although the risk appears to be minimal, it should be noted. The new agents in this class appear to carry a lower risk of causing tardive dyskinesia when prescribed at the usual doses for patients with other mental illnesses. Therefore, these newer medications are now more commonly prescribed for patients with borderline disorder than are the ones originally used.

Both older and newer subtypes of medications in this class may produce other side effects. These vary with the medication being used, and include weight gain, nausea and other GI symptoms, headache, drowsiness, insomnia, breast engorgement and discomfort, lactation, and restlessness. Some of these, and other side effects, are temporary, and others may be persistent, requiring a change in medication.  Because Latuda appears to produce less side effects such as weight gain and high lipid levels, I will often begin treatment with this medication. Although its effectiveness for borderline disorder has not yet been reported in the scientific literature, I have found it to be effective for the same symptoms as the other SGA’s mentioned. In addition, because it’s side effect profile is more tolerable for many patients, I have observed that  acceptance of the medication appears to be  higher. Before you start on any antipsychotic agent, or any medication for borderline disorder, you should review its side effect profile with your psychiatrist.

Mood Stabilizers

Another class of medications, referred to as mood stabilizers, has been shown to significantly reduce certain symptoms in patients with borderline disorder.27 These symptoms include impulsivity, anger, anxiety, depressed mood, and general level of functioning. The size of these therapeutic effects range from moderate to large.

Mood stabilizers do not reduce suspiciousness, split-thinking, dissociative episodes and paranoia in borderline disorder. When these symptoms persist after others improve with mood stabilizers, the addition of, or replacement with, an antipsychotic agent is indicated. if the symptoms responsive to antipsychotic agents are controlled, but other symptoms of the disorder persist, I will add a mood stabilizer to the antipsychotic agent in use.

The most commonly used and effective mood stabilizers for borderline disorder are topiramate (Topamax) and lamotrigine (Lamictal). These medications are also referred to as antiepileptic drugs because they are commonly used for people suffering from partial complex seizure disorder. Partial complex seizure disorder has its origin in the  medial temporal lobes of the brain, a brain region important in the generation of emotions and theMike control of impulsive behavior.

Weight gain does not appear to present a problem with Topamax, which may acutally normalize weight in some patients, or with Lamictal. The latter medication rarely may result in a serious dermatological problem, especially if the dose is raised too quickly.

Other Medications

SSRIs

Although recommended in the the Guideline for the Treatment of Borderline Personality Disorder published by the American Psychiatric Association in 2001,30 research since then has failed to demonstrate the effectiveness of SSRIs in treating the core symptoms of the disorder.27 Their primary use now in borderline disorder is in the treatment of co-occurring major depressive disorder, if present.

MAOIs

Another class of antidepressants, the monoamine oxidase inhibitors (MAOIs), may be useful in patients with borderline disorder who are resistant to antipsychotics and mood stabilizers. Two studies of the MAOI phenelzine (Nardil) have suggested that it may be effective in some patients.27 However, orally administered MAOIs have the potential to produce very serious, even life-threatening side effects if used improperly. Therefore, some physicians use an MAOI for patients with borderline disorder only after other medications have been tried, and the physician feels confident that the patient will follow the necessary rules that have been clearly outlined to him or her. A new skin patch delivery form of an MAOI (ENSAM) given at its lowest dose appears to eliminate the usual dietary concerns involved in orally administered MAOIs.

Tricyclic Antidepressants

The tricyclic antidepressants amitriptyline (Elavil, Amitril, Endep) and nortriptyline (Pamelor, Aventyl) may worsen the condition of people with borderline disorder. These and other tricyclic antidepressants should be used with caution in patients with borderline disorder.

Antianxiety Agents and Sedatives

Anxiety, irritability, agitation and poor sleep are common symptoms of borderline disorder. In other disorders, the benzodiazepines are frequently used for these symptoms. These include diazipam (Valium), alprazolam (Xanax), temazepam (Restoril), flurazepam (Dalmane), and triazolam (Halcion). These medications should be used with caution in patients with borderline disorder because of their high addictive potential and a reported capacity to increase impulsive behavior in patients with the disorder.

However, it has now been observed that in patients with borderline disorder who continue to have symptoms of anxiety, irritability and difficulty sleeping, buspirone (BuSpar) is effective in reducing these symptoms when they do not respond to SGA’s and Mood Stabilizers.

Some patients with borderline disorder also experience adverse responses, such as impaired perceptions and greater sleep deterioration, to the non-benzodiazepine sedatives such as zolpidem (Ambien). Therefore, if these medications are prescribed for you, be aware of this possible problem.

[Skippy]

Updated: March 2019Three classes of medications have been found to be useful in reducing the core symptoms of borderline disorder:

  Antipsychotic Agents
  Mood Stabilizers
  Antianxiety Agents
  Nutraceuticals

Antipsychotics (FGAs; Neuroleptics)

Symptoms Improved: mood dysregulation (labile & hyper-reactive), self-injury, suicide attempts, hostility, assaultiveness, illusions, suspiciousness, paranoid thinking, psychoticism, poor general functioning.

• thiothixene (Navane)

• haloperidol (Haldol)

• trifluoperazine (Stelazine)

• flupenthixol (Depixol)

Atypical Antipsychotics (SGAs)

Symptoms Improved:severity, anxiety, anger/hostility, depression, self-injury, impulsive aggression, suspiciousness, paranoid thinking, split thinking, personal sensitivity, interpersonal problems, positive, negative, and general symptoms

• olanzapine (Zyprexa)*

• aripiprazole (Abilify)*

• risperidone (Risperdal)°

• quetiapine (Seroquel)°

• lurasidone (Latuda)°

• clozapine (Clozaril)°

Mood Stabilizers:

Symptoms Improved: unstable mood, anger, irritability, anxiety, depression, impulsivity, interpersonal problems

• Antiepileptics
• topiramate (Topamax)
• lamotrigine (Lamictal)
• divalproate (Depakote)

Antianxiety agent:

Symptoms Improved: anxiety, irritability, depression, agitation

• buspirone (BuSpar)

Nutraceutical Agent

Symptoms Improved: severity, anger, depression, aggression

• omega-3 fatty acids

[lbjnltx]

Updated: December 2016Clinical Practice Guidelines for the Management of Borderline Personality Disorder, Australian Government National Health and Medical Research Council.,
https://bit.ly/2J1R8d0

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, lamotrigine and topiramate antipsychotic agents 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. 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 medicines 210 (e.g. monoamine oxidase inhibitors, tricyclic antidepressant agents, lithium).

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

[hope]

My BPD husband tried prozac - no noticeable difference.  Then he switched to Wellbutrin and Risperdol .  The doc (family clinician not psychiatrist) insisted that he needed to take it for the rest of his life if he wants to avoid being imprisoned.

I'm amazed we're finally living the life we dreamed of.  The crazy rollercoaster ride stopped, It's a miracle.

[bianda]

The doctor just added Topamax to my BPDD's meds... .she is taking Effexxor XR.  The doctor is trying to address the rapid cycling mood swings that BPDD exhibits and the binge eating.

Has anyone observed positive results with the use of Topamax?

I appreciate your input... .

Thanks,

Bianda :

[msrose]

Updated: December 2019

This site is good for getting user responses on drugs:
https://www.drugs.com/topamax.html

[trinity_n_fl]

I was given Topamax for a few weeks and I had to stop it. First, I would sleep an entire day every time they increased the dose. By the third week, I couldn't read out loud, which is very important for my line of work. Some folks call it Stupimax, and I can see why! But everyone's different. One of the good things is that one can lose weight on Topamax. Most psych meds cause weight gain, so that's a plus.

[bianda]

Thanks for the info.  I have been online looking in on this med. and everything talks about the weight loss, which in my BPDD's case is a good thing because she is a binge eater.  In addition, I read how it is also used to treat migraines which again in her case she also suffers. Also, it has been used with alcohol abusers which is my BPDD's drug of choice.  She demonstrates the rapid cycling Bipolar type and the Topamax is recommended for that particular type.  I know with any medication it is hit or miss because of biological differences so I can only keep my fingers crossed and hope this is the one that matches her.  I did read something about it being dopamax because it makes people act like dopes but I am hoping that won't be the case for her.  Whatever wiring is screwed up in her head I am hoping this med. will reconnect for her.  

Also she has an appointment next Tuesday with a therapist who specialiizes in DBT.  Let's hope she goes as he is an hour away from her college.  

Bianda

[mr_anderson1]

Mine takes topomax and it hasn't made her stupid or anything. Come to think of it, she is sleeping better. Her migrains have been reduced to one every 1 or 2 months. Both good and bad as I did enjoy the calm times when she's incapacitated. 8)

She has lost weight which has improved her mood immensly. I haven't noticed any change in her uBPD symptoms because of it, but she is working on them separately, without talking about it, by herself.  :

[HarvestJ]

My BPDwife takes Topamax for migraines, and it has helped to reduce their frequency, duration, and intensity. Her doctor is a very observant, sometimes I think sneaky, health care provider. I wonder if he doesn't suspect BPD and thought the Topamax might have an added benefit of a mood regulator. If so, he's a smart man.

[GENERAL ANNOUNCEMENT]

GENERAL ANNOUNCEMENT This board is intended for general questions about BPD and other personality disorders, trait definitions, and related therapies and diagnostics. Topics should be formatted as a question. Please do not host topics related to the specific pwBPD in your life - those discussions should be hosted on an appropraite [L1] - [L4] board. You will find indepth information provided by our senior members in our workshop board discussions (click here).

[Yvette]

The BPD in my life has decided to go off Paxil and is currently drug-free.  He's also decided to forego therapy, as "there's nothing wrong him - it's the rest of the world that doesn't know the difference between Right and Wrong as he does).

My question is, since he's off Paxil, was that really the wrong drug for him to be taking anyways?  He wasn't THAT great on Paxil, except that he didn't care about much and had less 'highs' and 'lows', for the most part.

I wanted to throw this Rx question out there if ever I am in a position to recommend something different to him or his doctor (unfortunately the medical attention he's received has been really lame and he's never taken seriously by medical personnel - he puts up a good front with them, I think).

Any suggestions or comments would really be appreciated!

[gingie]

This post reminds me of something that I learned last week in T.  I was telling my T how my exBP is supposedly now on a certain medication that was prescribed to him by his family doctor for depression/bipolar.  Hearing this had made me a little jumpy, why, I am not sure, being that I am not going to ever go back with him, but I can't lie, the thoughts of "What if this gets his mood regulated and he ends up being a pretty good guy",... .you know... thoughts like that.

First, she shook her head and told me that family dr.s OFTEN have no idea what they are dealing with in terms of mental stability/personalities, and push the depression/bi polar dx too much without having any indepth look into the patient.  She then proceeded with this:

She, my T, sat there and held out both of her hands, palm face up, and then closed both to make closed fists.  One fist represented depression and the other fist represented personality.  She said that the medicine that he is on may help to subside his feelings of depression, but that it will not touch his personality.  He is who he is at his core.  That's really something to think about, or at least I think it is.

[Abigail]

My husband had been on Paxil and Zoloft before he was diagnosed with BPD.  Once he was diagnosed, our doctor put him on Prozac (a higher dose is needed for BPD than what is normally used for depression) eventually building up to 80 mg. where he had the maximum benefit.  Studies have shown that Prozac works better than Zoloft in treating some of the borderline symptoms such as chronic anger and emptiness.  Both work equally well if one just has depression and nothing else.

  He is also on a mood stablizier, Tegretol, medication for his comorbid ADHD and he has an as needed antipsychotic that he uses when he begins to feel overwhelmed, stressed or the beginning of dysphoria.  This medication regimen has worked very well for him. 

  Going off Paxil cold turkey is not recommended as it can cause severe withdrawal side effects.

  Abigail

[Grace]

My daughter was first prescribed paxil but had a terrible time with this drug - she had bad headaches and was having visual disturbances (she was seeing flashes of light and having blurred vision).  She was taken off the paxil and put on zoloft and was taking a low dosage for a couple of years.  Though the zoloft certainly didn't cure her illness, I thought her depression and anxiety were eased some.  The doctor had just raised her dosage of zoloft but unfortunately dd decided that she didn't need to be taking that anymore either and now she is taking no medication and having no therapy.  Time will tell, but I don't think her strategy is going to help her deal with her many issues.  I don't think she ever sleeps, either.  I have read, though, that prozac is the drug of choice for treating some of the symptoms that go along with BPD.

Grace

[Abigail]

  BPD can not be "cured" but it can be managed with the right medication treatment much like diabetes, staying away from alcohol (they are "allergic" to alcohol) and addictive substances, and therapy, especially retraining the brain with positive affirmations and correct thinking.  And of course, getting all of the comorbidities diagnosed and treated as well.

   My husband would be considered "high functioning" and he has been treated by Dr. Heller with medication since he was diagnosed three and a half years ago.  He has improved greatly and has an additional medication that is taken on an as needed basis when he feels stressed or overwhelmed, or even before a stressful event that you are aware of (say, an upcoming situation that you know will be stressful).  If taken soon enough, it calms him down and prevents the development of a rage and eliminates the anger.  You do have to learn to recognize your moods so that you know when you need to take the extra medication.

   Therapy is much more effective and can be accomplished in a lot less time if they are being properly medicated.  Each circumstance and situation is different, but you are more likely looking at months instead of years of therapy.  Without the proper medication, therapy may take numerous years or may not work at all.

   Dr. Heller (https://bit.ly/2tTNTd5) has had numerous success stories of which my husband is just one.  One of my friends and several members of her family have also been helped tremendously by Dr. Heller, along with my neighbor's daughter and a friend of a friend.  My 26 year old daughter is also being treated for BPD but hers is a milder case and with more anxiety problems than anger.

  Abigail

[ian]

I think some are more capable of recovery than others. As has been pointed out A.J. Mahari made her journet before Dialectical Behavioral Therapy even existed and Rachel Reiland apparently had alot of success through old fashioned psychoanalysis.

I'm not one that thinks medication is the answer to this disorder, although it might make the hard work involved in recovery easier. What particularly interests me is that a new type of cognitive/psychodynamic therapy called Schema Therapy has been shown to "cure" a majority of BPs of their core symptoms within 3 years. This is where we need to be focusing our attention. Nothing so far has had these kinds of results.

[Yvette]

Here's my experience with my xBPD and medication.  He was given Paxil and you know what, it kind of lessened his rages and made him 'snap out' of things a lot faster.  He was more rational, I suppose?  Some of these medications take two or three weeks to kick in, but my ex and I noticed changes within two days.  I just read somewhere that the faster they work, the greater need (the brain has been starved for whatever is in them).

But the problem is - and you'll hear this a lot - is that anybody that has a pysch/mood disorder feels that they are 'cured' after taking the meds.  Heck, they don't need them at all!  They believe they can function just fine without them, and eliminate the very common side effects at the same time.  So nine times out of ten, they wean themselves off.  Or go cold turkey.

All I can say is that it breaks your heart to see the monster return a short while after.  You see it.  They don't.  And future attempts to encourage medication re-start gets more and more difficult.  It's my opinion that after they come off, they get WORSE.  My experience with my ex went from bearable emotional abuse, to devastating emotional abuse, to physical abuse AND damaged-soul-forever emotional abuse.  I obviously can't stick around for the next stage.

[evien]

My DD, my sister and DH's ex all have BPD, all dx'd by appropriate professionals. BPex wasn't buying any of it and never went back, let alone start meds of therapy. BPsis tried a number of meds (she adores medication, and therapy, for that matter), and hit on Pamelor as the one that worked best... .she gained weight, however, and since she's WAY body-dysmorphic that was the end of that, she undiagnosed herself (and is now batshte crazy off everything except opiates, to which she is addicted). DD is on a fairly high does of Prozac, and goes to DBT 2x/wk (1-on-1 and "skills group". We were referred to our/her psych and the DBT group through Marsha Linehan's offices at UW. The people we've met over the last year+, struggling with DD's issues, have all been crystal clear that treating BPD is a 2-punch deal, and that neither meds nor therapy are optional. Gotta have both. Can't dig out from under the burden of dysregulated emotions w/o the meds, can't lean to function normally w/o therapy.

Evien

[Abigail]

TonyC,

  I don't know if your ex was officially diagnosed with BPD or not but studies have shown that Xanax has been found to make BPD worse!  If a doctor is treating patients for BPD he should know that. 

  The meds my husband is on (prescribed by Dr. Heller) are not any of the ones you listed and are generally not sedating.  The Tegretol can be in the beginning but my husband takes it at night anyways.  One of the meds, Risperdal, is sedating but that only needs to be taken in a severe crisis.  And if you follow Dr. Heller's instructions perfectly, that will be a very rare event.

   Before being treated, my husband slept a lot.  Treated with the right medication, he is awake and productive.  He also has ADHD and takes Adderall for that. 

  Abigail

[Abigail]

Mrbluesky,

   There is a definite correlation between ADHD and BPD.  Conversely, at least 25% of those with BPD have ADHD as well (according to one study), although Dr. Heller suspects it is higher and so do I.  I know 13 individuals, including my husband and daughter, who have officially been diagnosed with BPD and at least 10 also have been diagnosed with ADHD.  I don't know enough about the other three individuals to know if they have ADHD or not.

   And of those who I strongly suspect have BPD, many of those have ADHD as well.  And the vast majority were untreated for their ADHD. 

   The book, "Attention Deficit Disorder--The Unfocused Mind in Children and Adults " by Dr. Thomas E. Brown is very interesting.  It describes the executive function deficits in those with ADHD and there is a chapter on emotional dysregulation.  When you read it, much of it sounds like BPD.  Check it out if you can find the book at a library.  I began highlighting the references in that chapter that sounded like a description of BPD and there were many.

  Abigail

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[rockwood]

Abigail,

I found your comment regarding Xanax very interesting. During the last couple of months, J was eating Xanax like jelly beans trying to manage the stress that he was under.  I've tried to find some research showing the counterindication for BPD.  Can you help?

Thanks!

[rockwood]

Well, now that I've read this, I can track back a block of rages to his hitting the Xanax bottle.  He stopped taking Prozac when we met because of the sexual side effects.  When he found out his ex was having an affair when she divorced him (3 yrs later), he got a script for Xanax.  Things went to hell.

He is also a big "straight" vodka drinker.  I wonder if he isn't allergic as Dr. Heller asserts.  He drank enough that I'm not able to correlate the two... .but I wonder.

Hearing descriptions of him and watching him in action as an adult, I would bet the house he's ADHD.  Can't shut up.  Going either 90 or nothing.  Can't finish ANYTHING.

Lastly, and honestly, an issue I might actually be able to discuss with him, are three concussions he suffered as a teen.  He tells the stories of these experiences all the time.

What I would give to get him to Dr. Heller.  Heck, what I would give to lay eyes on him again.

Great thread!

[AJMahari]

I was treated before DBT was created. However, I did, among other types of therapy have a lot of Cognitive Behavioral Therapy which DBT is an off-shoot of. I also wasn't ever suicidal nor did I engage in parasuicidal behaviour so really, even if DBT, in its initial implementation was available I wouldn't have been the type of client most in need of it as it was inititally implemented for and mostly targeted toward those with unending suicidality, parasuicide and severe self-harm. I did engage in self-harm for a period of time when I had BPD, but again, not as majorally as many.

Of course, DBT is much more widely applied to the treatment of BPD now than it was intitally.

I totally believe that pills cannot cure or really effect recovery from BPD at all. They, at best, control some symptoms of some things of some aspects of BPD but that's about it, if that. Not to be controversial here but I do have a lot of concern about all of the medicating of those with BPD going on. I think for some they are over-medicated and not "treated". That's not in anyone's best interest. Also the amount of side effects of lots of medications alone, let alone in the astounding combinations that are increasingly being given to borderlines likely is creating other problems or exacerbating things that may not be well understood in many individual's experience.

I would also like to add again from my own experience that I recovered from BPD without ever being on any psychiatric medication whatsoever. So I wonder how the professionals pushing the pills would explain that?

Interesting, in this thread the usuage of the words "cure" versus "recovery".

I just wanted to say that in my experience as one who has recovered and as one who didn't ever take psychiatric meds or anti-depressants on that journey or since, I know first-hand that "meds for life" aren't necessary.

Your reference to willpower is also interesting. I think that taking personal responsibility, making a commitment, and a stubborn determination were the definite foundational pieces needed in my recovery. Some may call that willpower but willpower is often also associated with the mere controlling of one's impulses and/or actions in terms of "self-control". Those with BPD must first find and ressurect the lost authentic self and cannot hope to have control over what is a lack of self, therefore, I would say that self control isn't a part of the equation until well down the road to recovery. Learning to control impulses is a part of the recovery process but after one recovers, it has been my experience anyway that it isn't any longer about controlling impulses. Recovery means that one has resolved the underlying abandonment trauma that drove the impulses - essentially what I refer to as "the abandoned pain of BPD" - that needed to be controlled in maladaptive and pathological ways so that the borderline false self could continue to keep the abandoned pain at bay and out of the conscious awareness of the person with BPD.

I think you are right on about the need to be stubborn, for sure, however

[Skip]

The use of medication in the treatment of BPD is commonly practiced by the leading treatment centers.  Robert Friedel MD maintains a very contemporary schedule of treatment models.  :)r. Freidel is recognized by the NEABPD and he has testified before the US congress. BPDdemystified.com

There is controversy (meaning not all clinicians agree) on which medications are best in the treatment of BPD largely because most of the drugs are prescribed "off label"... .meaning large clinical studies have not been performed to mediate the individual experiences and preferences of different clinics.  Here is the definition of 'off label"  click here

It's interesting to see Mary Zanarini's (Harvard) distinction in the use of the terms recovery and remission in BPD.  Zanari is also recognized by the NEABPD and these are good definitions for our use.

Extended Recovery=remission of symptoms and having good social and vocational functioning during the previous 4 years.

Recovery=remission of symptoms and having good social and vocational functioning during the previous 2 years.

Remission=remission of symptoms

https://bpdfamily.com/message_board/index.php?topic=117735

[back2normal]

GF had long taken 10mg of Prozac. When generic was prescribed, she unwittingly began taking a 20mg pill every day, effectively doubling dosage.  I noticed that impulsiveness was greatly diminished with the greater dosage, of not eliminated. Has anyone else noticed this improvement from Prozac?

[another_guyD]

My ex was on this. She gained weight and tried to commit suicide.

~AguyD

[AJMahari]

A word of caution here. Zyprexa has been in the news as a drug (you can read about this on lots of web sites by the way) that not only causes incredible amounts of weight gain but that is seriously being looked at and there are law suits emerging and being pursued against the drug company because of a high incidence of diabetes that appears to be associated with the drug. It is also alleged that Eli Lilly sought to supress this information.

My BPD/NPD ex was on this drug. Three things, she gained a lot of weight, she got diabetes, and it DID not help her paranoid issues. It seemed to slow down the shifts in moods ever-so-slightly but otherwise was ruining her health and not really helping her emotionally.

Just my two cents worth here but I would not want to have anyone I cared about enter such a study.

[Skip]

Interesting information AJ.

I did a quick Internet search - if I understand it correctly, these are known side effects that can occur with this entire class of drugs... .so your caution is very valid.  I saw one estimate that said 7-10% of patients.

The FDA said that there are tests that can be done to identify which patients are at risk. “Physicians can use the genetic information from this test to prevent harmful drug interactions and to assure drugs are used optimally, which in some cases will enable patients to avoid less effective or potentially harmful treatment choices,” ~Lester M. Crawford, Acting FDA Commissioner (12/2004)

The first lawsuit (State of Alaska vs Lilly)  alleges that the manufacturer was too aggressive in its marketing and did not disclose the risk adequately - and as a result, people have been needlessly injured. As I understand it, the state is not asking that the drug be pulled from the market.  But, who knows what's next in these things.

So clearly, if anyone is considering this route, they should be proactive with their physician about learning about the risks, the screening tests, the monitoring tests, and the alternatives.

Thanks for bringing it up.

Skippy

PS: What I looked at:

Drugs.com
https://www.wthr.com/article/state-no-alerts-zyprexa-side-effects

Zyprexa (Lilly),  Seroquel (AstraZeneca), and Risperdal (Johnson & Johnson) are the top 3 atypical antipsychotics - medicines less likely to cause side effects, such as tremors, than haloperidol, an older psychiatric drug.  Studies linking these drugs to weight gain and diabetes prompted the FDA to require warnings to doctors in 2003 and 2004.

Alaska is suing to recover money it claims it had to pay for Medicaid patients who suffered serious health problems after taking Zyprexa. The claim is that Lilly did not adequately disclose that using the drug, could lead to severe obesity, elevated blood sugar and diabetes.

Lilly claims that it met Food and Drug Administration labeling requirements; that  Zyprexa has helped 23 million people; and despite filing the lawsuit two years ago, Alaska has not restricted the use of Zyprexa and at times has sought court orders to administer the drug to Alaskans with mental illness.

Alaska is one of nine states suing Lilly over Zyprexa and the first go to trial. The others are Utah, Pennsylvania, West Virginia, Montana, Louisiana, New Mexico, Mississippi and South Carolina.

[Tania]

With my BPD my P-doc has prescribed to different types of anti-depressants and an anti- anxiety pill.  At times I feel overwhelmed as I have to take these meds at different times of the day.  I am not sure if it is the right meds.  They definitely helped bring me out of my depression and suicidal thoughts, but how will they help with the long term battle of my diagnosis?  I am also in therapy and understand that they help me with my communication of thoughts and feelings, but I don't feel like I am really getting to the root of the rest of my problems such as splitting and impulsive activities.