What is the role of medications in the treatment of borderline personality disorder (BPD)?

Updated: Nov 05, 2018
  • Author: Roy H Lubit, MD, PhD; Chief Editor: Caroly Pataki, MD  more...
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Answer

Pharmacologic treatment may be necessary for impulsivity, affective instability, and psychosis. Medications are at times useful. See the following:

  • Selective serotonin reuptake inhibitors (SSRIs) are greatly preferred to the other classes of antidepressants; they can reduce impulsivity and aggression; they are less dangerous in overdose than many other psychoactive drugs; care must be taken that they do not lead to suicidality, however

  • Low-dose neuroleptics (eg, risperidone) are effective in the short term for control of transient psychotic symptoms and can decrease general agitation

  • Treatment with the opiate receptor antagonist naltrexone may reduce the duration and intensity of dissociative symptoms in a small number of patients with BPD [8]

  • Patients with BPD tend to have strong placebo responses to medication; thus, impressive short-term improvement might occur and unexpectedly fade

  • Patients with BPD commonly take overdoses of their prescribed medication; thus, tricyclic antidepressants, lithium, and other mood stabilizers must be prescribed with great caution and as part of an ongoing therapeutic relationship

  • Benzodiazepines, although helpful with anxiety, create risks of increased impulsivity and dependency

See Treatment and Medication for more detail.


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