TREATMENT: Medications

[BPDFamily.com]

My wife has taken a changeable mix of psych meds for years.  Her most consistent diagnosis is actually bipolar II, though she has twice been diagnosed with BPD, both times during hospital stays last year during her big crisis. So she was actually originally put on the meds for bipolar.

My opinion is definitely mixed. They seemed to help a lot initially, and there's no doubt that she was more functional for the next couple of years. But in retrospect, while they helped some with "moods" (lifting her out of depression, backing her down from feeling like she couldn't slow down, etc.) they didn't help with the twisted thinking, blaming, etc.  And she didn't have any therapy until her big crisis last year.

So ... .I just don't know. Maybe things would be worse without the meds. Maybe not.

Even with bipolar (i.e. with no BPD present) - a supposedly more purely chemical disease where meds are considered a must - it is very difficult to get them right, and they often have to be tweaked for years and years.

[Auspicious]

My wife has taken a changeable mix of psych meds for years.  Her most consistent diagnosis is actually bipolar II, though she has twice been diagnosed with BPD, both times during hospital stays last year during her big crisis. So she was actually originally put on the meds for bipolar.

My opinion is definitely mixed. They seemed to help a lot initially, and there's no doubt that she was more functional for the next couple of years. But in retrospect, while they helped some with "moods" (lifting her out of depression, backing her down from feeling like she couldn't slow down, etc.) they didn't help with the twisted thinking, blaming, etc.  And she didn't have any therapy until her big crisis last year.

So ... .I just don't know. Maybe things would be worse without the meds. Maybe not.

Even with bipolar (i.e. with no BPD present) - a supposedly more purely chemical disease where meds are considered a must - it is very difficult to get them right, and they often have to be tweaked for years and years.

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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).

[Dixiechkk77]

My BPD partner has been "in the system" for a long time.  He has been previously diagnosed with depression, PTSD, disassociative identity disorder, bi-polar, ADHD, various addictions, and has been on different meds for all of these. He has tried a variety of different anti-depressants - after a while they seem to be less effective... .

So right now he is on Wellbutrin and Celexa (they work in concert), valproic acid (Depakote) for mood stabilization, and for real, full-blown rages, he takes Risperidone. Also for depression he takes a B-vitamin complex and a multi-vitamin.  It has taken a lot of adjustments to get to a helpful therapeutic level. And if he missses for a few days - well, I have learned to leave until he gets back on the meds.

It seems to me (but I am not a professional) that it just hasn't been studied enough in terms of chemical analysis of the condition. 

Definitely, nothing "really" improves until he is in continuous therapy. Of course, that has it's pitfalls too. As the therapist gets to the heart of his background, uncomfortable things are uncovered, and he can be overwhelmed, and need therapeutic breaks just to deal with all the personal discovery happening.

[kennumber777]

 Hello everyone.

   My BPD wife takes Benzodiazepam (to calm her nerves). She also smokes pot and has taken speed off and on. I believe this can make things worse! Can anyone confirm this?

[Matt]

Ken,

I'm not a doctor and I have no special knowledge of this stuff.

I assume the Benzo... .is prescribed?

Even if it is - and I think we all know that doctors prescribe stuff they shouldn't sometimes - surely she didn't tell the doctor that she smokes pot and uses speed.  My ex, who suffers from BPD, used to smoke pot (behind my back) when we were married, and when I found out I didn't say anything, because I thought it might be helping her control her rage.  But the amphetamines can't be good, and of coure they tend to be addictive.

What is your wife's behavior like?

And do you have kids?

Best,

Matt

[kennumber777]

  We don't have kids. She also would "hide" from me when she smoked pot... .but near the end she would just try to make me feel bad like I was trying to stop her from living when I would tell her how concerned I was about her pot. I noticed lately she forgets things. She left me and lives with a guy who sells pot for a living... .go figure!

[Ring of fire]

I  have a sister who is taking Lamictil ... all these years I was told she was Bi-Polar... she is currently in the hospital because she is having seizures... I spoke with one of her friends who also takes it... just as I suspect she feels my sister is lying... but we can't pinpoint why or what she is lying about... My sister drinks while on this drug... Is there any chance at all sh eis taking Lamictal for BPD and does not want to admit? Her friend is Bipolar and I was trying to explain to her about BPD... She think my sister loves all the attention... I also think it is odd she purposely has doctors treating her that she does not know...

[MomToOne]

My daughter takes it as a mood stabilizer. She is 17 and has been diagnosed with RAD, BPD traits, bipolar traits among other things. She takes it in conjunction with other prescribed medications.

It works in the part of the brain where seizures start, the limbic system. The limbic system is also described here as a pos. site for abnormality for a person with BPD:

theory of etiology consists of three different biological explanations for the development of BPD. The first one is that there is a problem in the limbic system, specifically in the amygdala and the hippocampus, in a person with BPD. Both the amygdala and the hippocampus are in charge of regulating the expression of emotions and particularly the expression of "fear, rage, and automatic reactions". All of these are very important components in BPD, where the people have excessive anger and also fear in their relationships, which is demonstrated through impulsive acts like self-mutilation, which is an example of an automatic reaction. The limbic system in general is considered the "emotional centre" of the brain. It has been found in studies that the volume of the amygdala and of the hippocampus are significantly smaller in people with BPD than in people who do not have any mental illness, indicating that there could be a link between BPD and a dysfunctional amygdala and hippocampus.

[Ramona]

Apparently there is a word limit here, so I will try to make my inquiry brief:I am almost 100% certain that my adult daughter suffers from borderline personality disorder.  After years of crises, dramas, dui-s, you name it,she has finally been seeing the same therapist for 5 or 6 months.

Even though she has been on Wellbutrin for that long, she cannot control her rage.  This morning she raged at her 7-year old daughter,felt remorse, and told her therapist about it.  He said that he thought she needed an anti-anxiety drug like Xanax or Klonapin (sp), as well as the Wellbutrin.I question Xanax because she is an alcoholic and I fear addiction to it.Does anyone here know of a psychotropic (sp) drug that would help her to control the rage?

[TonyC]

is she an alchoholic still drinking... or recovered? not drinking

tony

[tammy]

My daughter drinks. She was prescribed klonopin for anxiety. The results of her combining alcohol and klonopin were devastating; she would become very aggressive . Klonopin ( I think all benzos) is also one of the most addictive drugs (including illegal) out there. My daughter has been attempting to wean off for months now. I strongly suggest looking up the drug interactions on these meds as well as looking into benzo withdrawal sites... .It changed my daughter's life but not for the better and it made her anger worse! She now takes wellbutrin also along with zoloft (an anti depressant) which I think has some sort of impulse control component. Good luck!

[TonyC]

all of these meds... from reading my exes bottles and reading on line about the meds... she was taking...

drinking is an absolute no no... .

most of these drugs cant even be mixed cause of... .the interations...

they target things in the brain... and alchohol... .it dont allow the drugs to do that... .

i would think that for eany of these drugs... to work as prescribed... .there cant be any drinking... none...

my ex wanst an chronic drinker... but when she had a few... (cause she said she could)

i never knew what mood to expect... .cause the sedated... g/f wasnt so sedated after 3 beers... .

[tammy]

Absolutely right. Drinking is a no no with any of these meds... .I think drinking with BPD is a no no too! I guess everyone's altered by alcohol BPD or not. Unfortunately my daughter has not chosen to stop drinking so I was just relating how much worse the klonopin in particular made her while drinking.

[Ramona]

Heartfelt thanks to both of you.

Daughter would say that she is no longer drinking, but she insists that

she is able to have (deserves) "a cocktail or two" when she goes out.  She comes home almost literally comatose.  She is a binge drinker -- and since I only see her return home when I am taking care of my granddaughter, I don't know how often this happens.

Years ago she did stay in AA and stay sober for a year, but (according

to her) I caused her to start drinking again.

Now I am frightened that she will try the Klonopin.

Thanks again.

[dearestmommy]

My daughter is on zoloft and abilify when she chooses to take them  ?.   The abilify seems to help control the aggression and rages.   She has also been on lithium, lamictal, depakote.  She was on the lamictal and depakote together for years.  

[TonyC]

i took the liberty of looking it up this is a cut out from one of the sites i got when i put alchohol and klonopin in a search... and also dont spell this good...

Combining Klonopin (clonazepam) & alcohol can kill you. They both act on the exact same brain cell receptors (GABA receptors), so combining the two can be too much for the brain. They cause the brain to slow down, & when it slows down that part of the brain in charge of breathing enough, then you can stop breathing & die. Combining Klonopin & alcohol can also make someone more likely to have seizures.

 dearest... i know no more than you when it comes to meds... .i know what i know from experience... with the meds... .and my curoisity... .

drugs... like zoloft and many of the mind drugs... have to reach a level from regular daily dosages it could take a month... for the drugs to reach the level that your prescriber wahts her to reach,... .skipping days and or periods of time...

wont do what the drugs are suppodes to do...

[dearestmommy]

You and I know that.   I wish I could make her realize that.   She takes it when she is in the RTC but when she is not highly supervised like the IOP program she doesn't take them even though she tells me that she is.  Hence why she is now sitting in jail on assault on an officer charges because she hadn't taken her meds for over three weeks and becomes very agressive when not on her meds.  Gotta love it

[tammy]

These are some of the side effects listed on the klonopin website. I wish I'd checked this before my daughter started taking it!


Psychiatric: Confusion, depression, amnesia, hallucinations, hysteria, increased libido, insomnia, psychosis,(the behavior effects are more likely to occur in patients with a history of psychiatric disturbances). The following paradoxical reactions have been observed: excitability, irritability, aggressive behavior, agitation, nervousness, hostility, anxiety, sleep disturbances, nightmares and vivid dreams

[lbjnltx]

all of these side affects and klonopin is an anti anxiety drug?   

since alcohol is a depressant that's got to go    of course!

in my BPD13's case prozac for depression seems to work well when combined with abilify as a mood stabilizer and aid to prozac's affectiveness.  we have had to adjust the abilify over time since she started in july of 09.

the experts say the most affective treatment is medication when combined with therapy. 

i would like to add to that (personally) consequences!

best to you all

lbjnltx

[Skip]

Does anyone here know of a psychotropic (sp) drug that would help her

to control the rage?

Is your daughter being treated by a psychiatrist or a general practitioner?  Are they aware of the drinking issues?  That might be the first thing to tackle.

There are no specific drugs approved by the FDA for the treatment of BPD.  But, there are numerous drugs approved to treat the symptoms evident in those with BPD.  According to several published reports, SSRIs are considered to be the appropriate initial psychotropic medication prescribed to a person with BPD. Here is one reference: www.ajp.psychiatryonline.org/cgi/content/abstract/159/12/2048/f/SSRIworks.htm

SSRIs and related antidepressants   Symptoms Improved by One or More Medications in the Class - anxiety, depression, mood swings, impulsivity, anger/hostility, self-injury, impulsive-aggression, poor general functioning

• fluoxetine (Prozac)*

• fluvoxamine (Luvox)*

• sertraline (Zoloft)°

• venlafaxine (Effexor)°

Several of these serotonin uptake inhibitors, including the long-acting fluoxetine, have been found to decrease alcohol intake in moderately dependent alcoholics. These are not the primary drugs for treating alcohol dependence, it may be a better direction than Klonopin.  It's worth exploring with the prescribing physician.  Of course, no drug will help unless she tries.

www.ncbi.nlm.nih.gov/pubmed/7814825

As for the Klonopin, generally, when their are problems with a drug, the practice is to try an alternate from the group - other benzodiazepines, such as alprazolam (Xanax), chlordiazepoxide (Librium), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), or oxazepam (Serax)  Addiction-prone individuals (such as drug addicts or alcoholics) should be under very careful surveillance when receiving Klonopin because of the predisposition of such patients to habituation and dependence. As you pointed out, these drugs are addictive in there own right - as much as alcohol.  Is he giving her renewing prescription of this drug - or just a little to help with moments of anxiety?  Dod she request it?

None of this is to make a prescribing recommendation. This is just some information I have - and my knowledge base is not broad.  Hope this helps in your own research and in your discussion with the prescribing physician.

Skippy

[Anna17]

IMPORTANT: Just about any p drug is considered a no-no with alcohol. A lot of people ignore this prohibition and do okay. BUt I can tell you that Klonopin and alcohol can be a REALLY REALLY BAD mix.

As mentioned elsewhere on this thread, aggressive and even violent behavior is a common effect.

There's also, also elsewhere mentioned, the fact that alcohol and benzos can inhibit breathing and can even lead to death.

I know someone who, as a young person, was very cavalier about mixing drugs and alcohol and never had problems. Then one night he combined alcohol and Klonopin, and then found himself in the hospital strapped to a table with everyone giving him weird looks and his friends furious at him. To this day, he can't remember what he did. That's just one story, but it's apparently VERY common to act violent but then lost all memory about it.

[JoannaK]

Alcohol and the benzos are central nervous system downers... .  but they also act as disinhibitors.  Many people do things that they wouldn't normally do.  This is why some people just fall asleep after a couple of drinks and others get violent or act nutty in some other way.   Benzos have a similar affect.  They also cause memory problems, so that a person drinking and/or taking benzos may do something "bad" and then not remember it.

Also, many addicts take too many.  Even if not drinking, if the prescription calls for 3 X a day, a person with addictive tendencies may take "one or two more"... but... combine that with memory problems, and the person may be taking many more than he/she thinks he/she has taken.  People with addictive tendencies should not have control over a bottle of a benzo.  If it is necessary prescription, somebody else should hold their prescription for them and only give them the pill at the prescribed time.  (Try to get someone with BPD or someone who is an active addict to agree to that!    .) 

[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).

[Andarial]

It seems a common thing for BP's to smoke pot... .am I right? It likely has something to do with brain chemistry (seratonin), and I certainly hope that researchers are taking this into consideration. My partner always says that all he needs is a medication that will mimic pot. He smokes on and off, when he smokes pot he is delightful, loving, empathetic and thoughtful... . the problems come when he stops smoking, after smoking it for a few days. It has happened time and time again - when he stops smoking, he will go through what he himself calls a 'psychosis' where he will have uncontrollable rages, become irrational (much more than usual) and usually ends in him breaking our valuables and trying to get me to leave... .basically the standard BP behaviour, just magnified significantly.

The thing is, in a rare moment of clarity, he told me what it is like when he smokes pot. He says that it allows his 'walls' to come down, and he is 'allowed' to feel and respond and accept, and the walls that he usually puts up to protect himself from hurt are removed, to allow him to 'feel'. The conversation was so heartfelt and in-depth that it made me cry, and makes me teary just thinking about the raw and rare emotions he expressed.

He knows he can't smoke pot because of the 'psychosis' he experiences when he stops. As I said, I assume it is a brain chemistry thing that makes him more (and I hate to use the word) 'normal', but what would cause the sudden and predictable 'psychosis' and rages as soon as he stops? These rages will last a couple of days after he stops smoking then he will go back to his standard BP self.

[VB]

Hi, I know what you are going through with this one! My BF is also like this with pot. When he has it he is calmer, but still has BPD episodes, but when he does not have it the rage is 10 times worse. If he has it, it is just an easy way out of the BPD, but when he does not have it... .woah! He has stopped for a week, and everything seems ok at the moment, but I am just waiting for the next and final flair up... .

[atwittsend]

  Andarial

Withdrawal from drugs is excruciating.  I used to smoke so much pot that if I ran out I would go insane.  I seemingly outgrew this.  I can take it or leave it these days.  

that said my ex doesnt like getting high she says.  but we did get high several times and it was amazing.  she laughed with her belly and was genuinely happy in those moments.  she never raged at me when high.  there were no eggshells.  it was just normal being high with a friend.  

[midgelette]

Just wanted to add to this thread.

When growing up-early teens with my BPD/NPD(since childhood) older sis, I would revel in the occasions of her being stoned on pot. They were the times when I could exert my personality freely... .it actually became a joke. She was very mellow and happy, not at all feeling threatened by me and I had some freedom to be. This was before I started to defend myself ofcourse.

In recent years, if my sis takes anything natural that may have some neurological benefit like cordyceps or Nuerozyme (Vitamin combinations), she will get totally whacked out for the day-often can barely function and that is that. It is the weirdest thing. Her brain must be so unstable. Of course she would never go on meds and more than one experience with any natural supplement for the brain, doesn't happen due to the effect she feels-out of control.

[anker]

Are there any actual medications that they prescribe for BPD? My ex had Prozac geodom and something else. A downer. None of it helped... .(he smoked pot too but it didn't make a lot of difference)

[GreatDad]

My stbxw, who has been dx'd with depression, ADD and bulimia (claims to be in recovery, but I still see bingeing) is on the following:

200 mg/day lamictal
90 mg/day cymbalta
90 mg/day buspar
2 x 20 mg/day adderall (xr)
.5 mg xanax prn
ambien at night for sleep.

Isn't this heavy duty stuff, and is it good/bad/irrelevant to BPD?

Comments from anyone with med expertise or experience would be appreciated.

[zero0zero0zero0]

I just saw this link posted by another member.  It's a start.  
https://www.healthyplace.com/personality-disorders/borderline-personality-disorder/borderline-personality-disorder-articles/

It says xanax is a no no as well... Alexis

[Tenacious]

I haven't tried anything yet.  My homeopath charges about $325.00 (includes meds) but I wanted to just put it out there if anybody else has tried anything with any success.  I have used homeopathics for years, and I know that the results can be amazing.  It's just right now between the psychologists, the boot camp I am looking into for the summer ($$$) and the possible boarding school for the fall ($$$$$) I'm trying to be very careful and don't want to waste the money if it won't be effective.   I also don't think that she would be co-operative about even taking the meds right now.  Tried some from the psychiatrist, and she would take them at our insistence,and then just throw them up. 

I'm feeling a little desperate in these days.  Thanks for your reply.  And good luck!

Tenacious

[Auspicious]

He refuses to take the meds prescribed by the psych because he is afraid of their effects.

The way I look at it is: any substance with a powerful enough psychoactive effect to even possibly treat serious symptoms is also going to likely have side effects and risks.

It's not as if over here you have "natural" things that can only do you good and no harm, but over there you have "artificial" things that can only do you harm but no good.   

In both cases we are talking (if there's any point in using them at all) about substances with powerful effects on the brain and nervous system.