Borderline personality disorder is tricky to treat with medication. This is because many of the behaviors and thought patterns associated with it are typical of many different psychological problems. Therefore, the proper medication must be chosen on a case-by-case basis depending upon the most prevalent or notable symptoms an individual with BPD is exhibiting.
Those who are especially anxious may benefit from benzodiazepines, those who exhibit psychotic features may benefit more from atypical antipsychotics, those especially prone to difficulty in mood-regulation may benefit from mood stabilizers, and those especially prone to depression may be better treated with antidepressants.
In the following study, 28 studies, consisting of 1,742 research subjects, were reviewed. atypical antipsychotics, omega-3 fatty acids, and mood stabilizers were possibly helpful. However, much more research is required on the subject. Some evidence suggests that typical antipsychotics and antidepressants may help somewhat. Unfortunate, the data on the pharmacological treatment of BPD is quite sparse and much more research needs to be done on it in general.
A red flag went up in the use of olanzapine for the treatment of BPD, since it appeared to correlate with an increased risk of self-harm among those who were taking it. Ultimately, the treatments with the most beneficial effects appeared to be omega-3 fatty acids, mood stabilizers and atypical-antipsychotics.
According to WebMD, olanzapine (Zyprexa), risperidone (Risperdal) and quetiapine (Seroquel) have all been used to treat borderline personality disorder. These antipsychotics belong to a specific class of antipsychotics known as atypical antipsychotics. These drugs are not without their side effects. Numerous mood stabilizers and atypical antipsychotics have been used in the treatment of BPD, and the choice of medication depends largely upon what sorts of symptoms are particularly severe in the individual’s BPD. Olanzapine and quetiapine are the most effective among atypical antipsychotics. Both classes are drugs help a great deal with affective disorders, aggression, anger and rage, impulsiveness, anxiety and depression.
In one study of lithium carbonate with desipramine, 10 patients with BPD were studied in a 6-week double blind, placebo-controlled trial. The medication helped a great deal with anger and irritability as well as self-harming. In another review, lithium and carbamazepine have both been helpful in treating antisocial personality disorder as well as borderline personality disorder, alleviating aggression and halting behavioral deterioration.
Oxcarbazepine was tested in a 12-week pilot study. Thirteen patients diagnosed with BPD and exhibited significant improvements in impulsivity, affective instability, anger, anxiety and interpersonal relationships.
Divalproex sodium has been comprehensively analyzed in the treatment of BPD. It significantly helps agitation in both bipolar and borderline patients. In one study, a double blind study was conducted on 16 BPD patients, which resulted in global decrease in symptomatology, reduction of suicidal ideation and gestures, as well as reduction in aggression, depression and irritability. Another study entailed a 12 week double blind experiment with 52 BPD patients. Valproate was found to treat impulsive aggression. Another 6-month controlled study with 30 BPD patients also diagnosed with type II bipolar disorder, anger, hostility, aggression and interpersonal sensitivity were improved with the use of the medication.
In a study of lamotrigine with 8 patients, whose progress was followed over one year period, total function improvement was approximately 40 percent, including particularly significant improvement in substance abuse, suicidal behaviors and sexual impulsiveness. This drug is also helpful in both mood disorders and in treating the mood instability typically associated with BPD. Another study found that lamotrigine was useful in treating all facets of BPD, especially emotional instability and impulsiveness. the study involved the determination that 40 percent of 35 bipolar patients could also be diagnosed with BPD. In yet another study, 24 female patients w ith BPD exhibited significant improvement in controlling anger when lamotrigine was compared with placebo.
Next, let us look at atypical antipsychotics. While typical antipsychotics block only dopamine, atypical antipsychotics block not only dopamine, but also serotonin. Clozapine has been found to be helpful in treating psychotic symptoms associated with BPD as well as aggression.15 patients diagnosed with BPD, in another study, was found to help with emotional instability and aggressive behavior, as well as with global psychopathology in general.
In a study with olanzapine, 9 patients with BPD exhibited improvement over 8 weeks in global psychopathology and functioning, hostility and impulsiveness. A few other controlled studies of olanzapine have been conducted as well. In one 6-month, double-blind, placebo-controlled study of 28 female patients with BPD, olanzapine was found to help with paranoia, interpersonal sensitivity and anxiety. In a study of 40 patients with BPD on a double-blind, placebo-controlled study over 12 weeks, helped anger and global psychopathology. In another study of 45 female patients with BPD, fluoextine, olanzapine and olanzapine-fluoxetine combinations were examined over 8 weeks in a doble-blind, placebo-controlled manner. Olanzapine monotherapy and olanzapine-fluoxetine combinations were notably superior to administration of fluoxetine alone. In another study, administration of olanzapine vs. placebo in combination with dialectic behavioral therapy was examined over 12 weeks and with 60 subjects. Olanzapine significantly reduced anxiety, aggression and depression.
Quetiapine was investigated in relation to BPD over 8 weeks with 10 patients, and it was found that the drug dramatically helped impulsiveness, social functioning and hostility. Another 12-week study on 23 patients diagnosed with BPD found that the drug helped dramatically with social functioning, anxiety, depression, hostility and impulsiveness. In yet another 12-week study on 14 patients, quetiapine helped dramatically with social functioning, explosive anger, impulsiveness, anxiety and global symptoms.
