What is the role of SSRIs 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

SSRIs are strongly preferred to the other classes of antidepressants. Benzodiazepines are contraindicated because they reduce inhibitions and are therefore likely to increase impulsivity; furthermore, patients with BPD are prone to sedative addiction. Risperidone and naltrexone may be considered.

Selective serotonin reuptake inhibitors

When used at high doses, SSRIs appear to reduce impulsivity and aggression; however, their antidepressant effects are less impressive than those of other drugs. An important advantage of SSRIs is their relative safety; this is especially important because patients with BPD commonly take overdoses of their prescribed medication. The use of TCAs, lithium, and other mood stabilizers is usually not indicated without specific relevant symptoms and a strong, ongoing therapeutic relationship.

Because the adverse effect profile of SSRIs is less prominent, improved compliance is promoted. SSRIs do not have the cardiac arrhythmia risk associated with TCAs. Arrhythmia risk is especially pertinent in overdose, and suicide risk must always be considered in the treatment of a child or adolescent with a mood disorder.


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