TREATMENT: Medications

[BPDFamily.com]

I was on Resperadol, but I started lactating milk and it really scared me.  My P-doc took me off of it right away.  I am currently on Clonazepam, Remeron, and Effexor.  Sometimes Zoplicon if I can't sleep.

[Tania]

I was on Resperadol, but I started lactating milk and it really scared me.  My P-doc took me off of it right away.  I am currently on Clonazepam, Remeron, and Effexor.  Sometimes Zoplicon if I can't sleep.

[hardatwork]

I was on Resperadol, but I started lactating milk and it really scared me.  My P-doc took me off of it right away.  I am currently on Clonazepam, Remeron, and Effexor.  Sometimes Zoplicon if I can't sleep.

My BPD "friend" (quotes because it's not clear what that means right now) also takes a regimen of Resperadol, Clonazepam, Remeron, & Effexor.  For her, it's the best combination of meds she's tried (and there have been many attempts)--it really works well for her.

[Abigail]

Depends on the doctor and what other comorbidities are present.  Remeron is a sleeping aid, not necessarily just for BPD.  My husband who has BPD, takes Prozac and Tegretol on a daily basis and uses Haldol and Risperdal or Abilify on an as needed basis.  My daughter who also has BPD, but a different type than my husband, takes Prozac on a daily basis but does not need to take the Tegretol.  She also uses Haldol on an as needed basis.  She takes Remeron for sleep and Buspar for anxiety.  And they both take either Adderall or Vyvanse for their ADHD.

Prozac and Tegretol have been shown in research studies to help those with BPD.  The use of a low dose antipsychotic like Haldol has also been studied and found to be effective.

Our doctor explains that it is not just the medication, but the dosage, sequence and timing.  And all of the comorbidities need to be treated such as anxiety, PTSD, OCD, ADHD, etc, whichever are present.  His website at www.biologicalunhappiness.com explains more about BPD and how and why he treats it as he does.  He has had a lot of success with his treatment plan.

[Karma Police]

There have been so many moments of clarity over the last two years that I am beginning to get used to a permanent look of "WOW" on my face.     This is one of those moments.

I took my D6's father, whom I now heavily suspect is BPD (of the waif-ish variety), to the emergency room for a psych eval after he told me he wanted to kill himself after I ended the relationship.  That was one of the worst days of my life.  That's the beginning of this story and how it pertains to your question.

After he finally moved out, he told me that he had started seeing a therapist (something that he actively refused to do during the tenure of our relationship) AND a psychiatrist.     They put him on Prozac--perhaps Zoloft--and Seroquel.  Forgive me for being a little slow on the uptake here, but I just put two and two together.

I would describe what took place after he left our relationship as nothing less that him being euphoric.  I couldn't understand why he had such a HUGE change.  So huge that he actually quit counseling after four sessions (why in the hell is that the magic number?) and got married four months after he moved out to someone he knew at work.  He said to me "When you know it, you just know it."

How profound.   :

So, the question remains... .how has it affected him?  Well, he certainly lost inhibitions, which is a good since he was completely agoraphobic, but very bad because less than a month after leaving our house this woman was sleeping in his bed with our child in the same room (he lived in a one-bedroom apartment).  Very confusing for our two-year-old girl.  He's still an asshat, still makes wacky accusations, and still tries to engage me in these constant pissing matches.  When I ignore him, it just gets worse.

So I guess my answer is this: medication+no therapy=bad.   

[Abigail]

Antipsychotics can work as part of the BPD treatment.  But success depends on more than just using antipsychotics.  Several medications are usually needed to effectively treat BPD, along with therapy that also includes some type of cognitive behavioral therapy. 

And you need to treat all of the comorbidities as well.

   Our doctor has found a successful treatment plan that has worked very well.  So well, in fact, that people have come from all over the world to see him for their BPD.  My husband is a totally different person because of the right treatment.  And I know several others who have had some dramatic changes as well. 

   When used correctly, with the right timing, the results can be rather amazing.  But again, it's a little more complicated than simply giving someone an antipsychotic. 

  Abigail

[peacebaby]

My dBPDso takes risperdal, gabapentin, and prozac every day--I think risperdal is the anti-psychotic, but it could be the gabapentin. Anyway, the doses she takes keep her non-zombi-fied, and she has less psychotic behavior than she used to, though it still does happen sometimes. I can't imagine what she'd be like if she weren't on these meds. And at the same time, she's preparing to re-evaluate them, because ya never know, she could potentially be less symptomatic if the doses were changed or she switched or added one... .

Peacebaby

[KissMyBass]

I've noticed that the person's BPD got way worse once they stop smoking marijuna. Is there any research on

marijuana and BPD? Or any other natural treatments? It seemed to be a better mood stablizer than anti-depressant/anxiety pills, without turning someone into a zombie like the pills do. But once they stopped the marijuana, their behavior became much worse physically, mentally and verbally. This continues to go on a year after they had stopped marijauna, which rules out it got worse due to THC withdrawl.

[Skip]

My limited understanding of the role of pharmaceuticals in BPD therapy is to stabalize the patient so that  talk therapy can be undertaken.  The real healing come out of explorations of the past as well as the use of behavioral modification methods such as CBT, DBT, Schema, Mentalization, etc.

The use of drugs alone, is not seen as very affective - it just takes the edge off.  Alcohol does the same for an alcoholic.  People affected with BPD are prone to drug abuse already.

Leland Heller has made numerous statements about using drugs to treat underlying conditions that could be exacerbating BPD - like thyroid defiencies, or clinical depression, etc.

Joel Paris.MD, made the comment below about the use of pharmaceuticals in the treatment of BPD per se' last January... .

"The problem is that there is no science to support polypharmacy [use of single or multiple drugs], and it's probably bad for patients," he said at the meeting. "When you give patients with classical depression an antidepressant, they may be cured in a few weeks. But you never see that in patients with borderline personality. It might take the edge off, but patients never go into remission." Paris is a professor and chair of the Department of Psychiatry at McGill University in Montreal and editor in chief of the Canadian Journal of Psychiatry. He is also a past president of the Association for Research in Personality Disorders.

If the pharmaceuticals have not yet been studied - it's probably a fair guess that herbs and alternatives have not yet been studied either.

[geroldmodel]

Well in my experience my ex-BPD would not rage as often when she was stoned... . 

I doubt it would help on a long-term basis to get the "edge" off.

[Cynmari]

I have to say that my husband is much cooler to be around when he's stoned... .he's always been that way for the 11 years I have known him.  As a matter of fact, I know that I have enabled him to keep on smoking because it keeps the peace for the most part around here.   When he doesn't have any, he becomes a real ass and no one wants to be around him.  That's when the real BPD traits come out... .

So, maybe it's different in everyone... .

C

[peacebaby]

My dBPDso takes meds for her condition, but she also self-medicates with mary jane on a regular basis. In general, it works for her--when she's feeling really anxious or depressed or she can't stop thinking in a way that makes her feel really negative, smoking some weed will calm her, get her focused on something other than her negative thought process, and then put her in a place where she can either calmly talk about what's bothering her, or say she'll think about it later when she's calm and sober 'cause in that moment she's feeling too good to ruin it.

At the same time, it's weed, so it not only takes the edge off her symptoms, it takes the edge off her drive to do stuff. But for now, I'd rather see her calm and not incredibly productive, than more productive and totally stressed out of her mind to the point of madness.

Smoking weed also takes the edge off being around her sometimes! 

Peacebaby

[black2thefuture]

this post couldn't be more true to my own experience with my gf. sometimes, i think that it's the most effective medication she's taking.

My dBPDso takes meds for her condition, but she also self-medicates with mary jane on a regular basis. In general, it works for her--when she's feeling really anxious or depressed or she can't stop thinking in a way that makes her feel really negative, smoking some weed will calm her, get her focused on something other than her negative thought process, and then put her in a place where she can either calmly talk about what's bothering her, or say she'll think about it later when she's calm and sober 'cause in that moment she's feeling too good to ruin it.

At the same time, it's weed, so it not only takes the edge off her symptoms, it takes the edge off her drive to do stuff. But for now, I'd rather see her calm and not incredibly productive, than more productive and totally stressed out of her mind to the point of madness.

Smoking weed also takes the edge off being around her sometimes! 

Peacebaby

[ian]

Cannabis can make some people more mellow while on it, and others more agitated. Of those who react well to it I have seen habitual use makes them really cranky when they stop smoking because they have lost their ability to cope with things.

I don't really think THC would help BPD. On the other hand another illegal drug called MDMA is apparently having some pretty profound (initial) results when used in psychotherapy for PTSD. I think there have been a few articles about this (Washington Post is one)

[Skip]

MDMA (3,4-methylenedioxy-N-methylamphetamine) is Ecstasy (also E, X, or XTC). 

The government approved the use of MDMA in research studies in 2004.  Back in the 1980's, MDMA was used in psychotherapy experiments - it reportedly facilitated self-examination with reduced fear.  These experiments stopped when the drug was outlawed.  It is currently outlawed worldwide (UN provision).

The  risk of permanent neurotoxic damage of the central nervous system is a major concern that is not fully understood.

Skippy

[ian]

From the literature I have read the MDMA PTSD studies (one in the US and one in Israel and Switzerland) are controlling for BPD, but the idea is that if it proves successful in clinical trials they may look into other related disorders such as BPD. I'm sure BPD is going to be much more challenging because of mood instability and ingrained thinking patterns.

From the preliminary findings, with a moderate dose of pure MDMA in a controlled environment (not dancing yourself into heatstroke at a rave) administered 1-3 times spaced months apart no neurotoxicity has been reported. We do know that if you pump rats and monkeys with heavy doses for several days there are at least semi-permanent changes to the seratonin system. And we also know that some ravers who have used street Ecstacy hundreds of times show lower seratonin, defecits in short term memory and mood problems. But then you have to wonder if they were like that in the first place to use the drug so heavily.

It has been shown that using MDMA and can lower your seratonin levels for 2-3 months before returning to baseline and it can mess with a person's mood for a week or two after using.

I am interested to see how this research turns out.

[peacebaby]

Just had to chime in regarding my real-life studies of how X effects my dBPDso... .When she's on X she is amazingly calm and expressive and able to discuss things that otherwise are very upsetting in a calm fashion--never mind how the X takes away her incest-induced sex issues! It is still amazing to me how different she is on X, as if the drug really levels out the natural drugs she's missing in her brain. She gets depressed when coming down, but who doesn't? I don't see any long-term positive effects, though I'm not sure how I'd know they were because of the drug and not her meds and therapy and her work on herself. (And just for the record, we only take X like 5 times a year or so.)

Peacebaby

[massimo]

I would not wish to advocate the use of an illegal sustance under any circumstances, but I put this out in hopes that perhaps others have experienced this.  My uBPDw sometimes has pot on hand, and during these times, I notice a very sharp reduction in her irratibility, while the raging becomes non-existant.  She is also easier to talk to and doesn't get sidetracked with fears and worries as much.  This, to me, is noticeable not just when she is actually using it but a day or two later.  It isn't very scientific at all, but there appears to be a correlation in her case.  I was wondering if anyone else had noticed this kind of reaction, or perhaps knows if there have been experimental studies done on the effects of cannabis on emotional illnesses.

[inblack]

My girlfriend used marijuana heavily for 2 years.  I mean I don't think I was ever around her when she wasn't high.  I let her do it despite the fact I was really against the whole thing because it did seem to stabilize her moods.  But after heavy use for months on end it would start to have the opposite effect and she'd get angry when high, oddly enough she was still LESS angry than when she wasn't using.  Around this time she'd usually take a break and go clean for a few weeks and then start up again and the marijuana would again stabilize her moods for months.  She was definitely self medicating and I think she knew it.

It made her extremely paranoid though when she was high (which is the reason she eventually quit), and caused extreme anxiety which has not gone away even though she has been clean for months.  I guess it takes awhile.  I'm worried its not going to change though.

As for her moods now, if anything they've gotten a lot better.  I think that marijuana helped her understand her true feelings.  It was like I could tell her things or she could feel things without that intense wave of emotion that blocks her from understanding her real thoughts and feelings.  She used to tell me she could think without feeling when she was high.

It does seem that she is going back to the way she was though. Its only been 4 months since she stopped using and every month that goes by she seems to regress further.  My guess is she forgets what she learned about herself, its not maintained or whatever and losses the effect it had on any change she was making.

[cieeciee]

Can anyone explain what the purpose of prescribing Risperdal to a person who may have BPD? My mom fits most of the criteria for BPD and has been in psychotherapy for over 35 years. I just found out she is on Risperdal. Can anyone tell me why someone with BPD might be prescribed this medication? She is on Xanax, Effexor and Risperdal. I suspect she is BPD. She won't tell me, so I am trying to put these pieces together on my own.

In my opinion, she matches several criteria for BPD, PPD and NPD. Would the anti-psychotic be for the paranoid delusions which she exhibits or something else.?

Thanks,

cieeciee

[cult]

Risperdal should help her with the irrational thoughts which might trigger rages. It can also be used as a mood stabilizer. I have had many students taking this.

Not sure how effective/wise it is to give stuff this strong to teens, but that's another story!

Cult

[michelle]

My mother was on Risperdal after she attacked my brother with a hammer.  She was having delusions and thinking he was out to kill her, talking to "hit men" that weren't even there, thinking bombs were planted in her room... .you get it.  It calmed her down to where she didn't act this way anymore. 

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[ian]

Risperdal is an anti-psychotic medication usually prescribed to schizophrenics. It blocks dopamine receptors in your brain because an over-abundance of dopamine can cause paranoid and psychotic thinking. Too little can manifest itself in depression and parkinson's-like symptoms.

I've read some doctors are into prescribing BPDs risperdal and haldol because it apparently can help with the reality breaks and paranoia. Anti-seizure medications are also popular since there are claims they help with the rages.

[tabbycat]

So I am in the same situation as cieeciee, and my uBPD mom says she is on Risperdal for anxiety.  From what I'm reading, it sounds like the only reason Risperdal would be prescribed is for schizophrenia, bipolar disease, delusions, paranoia, BPD, or irrational thoughts.  So am I correct in assuming that if my mom has been given this medication by a doctor, then she has a diagnosis of mental illness?  The only thing she will ever admit to is depression and anxiety.  I am pretty convinced that my mom is BPD, but I obviously can't ask my mom. My sister and I have thought about trying to contact her therapist, but knowing there is a confidentiality issue stops us from thinking it could be helpful.  My mom definitely exhibits behaviors of BPD, paranoia, delusions, and NPD now, even on all the medications she is on.  She doesn't seem to exhibit the rages she used to when I was younger but I always assumed that was because now that she has grandkids she has more to lose if she makes me mad.  Also, I've learned myself how to deal with her better.  But maybe if she weren't on Risperdal she would still be having the rages.  I wish that saying she was on the meds would make her a better mom, but it hasn't.  I just don't have to listen to her midnight rantings anymore.

Has anyone else ever contacted a BPD's therapist for more information? Did you get anywhere? was it useful at all?

[jodie]

Risperdal is also frequently utilized to potentiate antidepressants.  It helps enhance the effect of the antidepressant in folks who have a somewhat resistant depression.

[cieeciee]

Thanks everyone for your help. So, if she is on this medication, what does it mean that she is still have paranoid delusions that people are "out to get her." or thinking bad things about her? She truly believes that these are these people's motives.

Does an anti-psychotic med just reduce the severity of these symptoms or is it supposed to stop the delusions all together?

I am very concerned because my mom has minimal communication with her Psych (once a week) and therefore, it seems that medication is her main form of treatment. Meanwhile, even though she seems better than in the past, she still has paranoia, anxiety and compulsive spending behaviors.

Should her meds be helping this or if she is still exhibiting these behaviors could that mean seeing a psych once a week isn't the best treatment?

I know no one can diagnose or treat my mom in this forum, but I am trying to figure out if she is getting the helps she needs, but can't ask her or her doctor. Any experience from someone else would be helpful.

Thanks for any insight, or thoughts about this.

cieeciee

[cieeciee]

how does she act on the drugs... tired , lethargic... .

It is very hard to separate out all of her maladies from what side effects may be occurring from a drug. She is on several meds for all kinds of physical problems, beyond mental health issues. It is also possible, I suppose, from what I have read, that her diabetes and morbid obesity may have been complicated or induced by taking the Risperdal. I have no idea how long she has been taking the drug.

I do think her mental illness is severe enough to warrant meds, but didn't see Risperdal written about in connection with BPD very often. In fact, most of what I have read indicates that psychotherapy is the most critical component of treatment for BPD. My mother has been in psychoanalysis for 35+ years and I am still not sure after all this time that it is really effective in her case.

Since Risperdal doesn't seem to be very common with regard to a BPD diagnosis, it makes me wonder if she has another condition. Just trying to put the puzzle pieces together.

Thanks.

[JoannaK]

The big key for recovery from BPD... .  meaning the symptoms are improved enough that the person can live a reasonably "normal" life... .  is that the person him or herself must realize he/she has these issues, he/she must take responsibility for disordered thinking and behaviors, and he/she must be committed long-term to recovery.  Meds alone can help with some of the symptoms, but they are no panacea.  There are several effective therapies, the most effective is dialectical behavioral therapy.  Here's a post on what it means to fix BPD:  https://bpdfamily.com/message_board/index.php?topic=76487.0 

[cieeciee]

The big key for recovery from BPD... .  meaning the symptoms are improved enough that the person can live a reasonably "normal" life... .  is that the person him or herself must realize he/she has these issues, he/she must take responsibility for disordered thinking and behaviors, and he/she must be committed long-term to recovery.  Meds alone can help with some of the symptoms, but they are no panacea.  There are several effective therapies, the most effective is dialectical behavioral therapy.  Here's a post on what it means to fix BPD:  https://bpdfamily.com/message_board/index.php?topic=76487.0 

Thanks JoannaK. That was very helpful.

[duet_4-8]

My son and daughter-in-law visited with my exuBPDh last night, and DIL (a medical student) told me there was an RX for Zoloft with his name on it on the table. Which frankly amazes me because he flatly refused to even consider asking for any type of meds for his mental state in the fifteen or so years that I felt he could benefit from them, and condemned me to no end for once, in 1994, taking prescription antidepressents. He even brought it up in court last Spring in an effort to make the judge order me to get drug tested, too.  ? (Which btw didn't work out so well for him... .) I guess he preferred his own self-medication with opiates and benzos to something that might actually help him... .

Anyway, just wondering if Zoloft has any effect on BPD beyond the obvious depression-related symptoms.

[bornskippy]

Hi Duet.

It is my understanding that there is no specific drug to treat BPD per se as it is a disorder not a mental illness. I am sure you are aware of this.

As you are also aware, zoloft is an anti depressant. If taken correctly, and likely the initial dose will need to be increased, you may find that some symptoms that are related to depression may abate.

The things that could possibly change are (in my un-medical understanding); his suicidal threats/tendencies may lesson. It may balance out his moods to a degree, although I am a little iffy on whether it would actually stop anger outbursts. He MAY get to a point where he is able to more objectively see some of his issues (given that he is no longer looking through the haze of depression). While as I'm sure you know these are symptoms of depression they are also intertwined with the outward displays of BPD.

It may not change him externally in the slightest.

BPD as you know is a coping mechanism that involves deep and extended therapy to develop new ways of coping with internal turmoil. There is no quick fix unfortunately.

I hope that in your situation, the zoloft, if even taken, turns out to be helpful in even the littles way. Every bit counts I guess.

bornskippy. 

EDIT: Duet, obviously not knowing the specifics of your situation I was talking in a very general sense about how the medication might effect a person with depression and BPD. Some of those things I mentioned might not even be applicable to your exh.