BPD Medication: Types, Treatments, and More

Borderline personality disorder (BPD) is a long-term mental health condition characterized by extreme mood, self-image, and behavior changes.

This leads to heightened impulsivity linked to self-harm and suicide.

People with borderline personality disorder usually have difficult relationships with others and may have a history of experiencing trauma.

This condition is not uncommon and affects up to 1.4% of adults in the United States. 

Although psychotherapy is the primary treatment for BPD, your doctor or mental health provider may add medication to your treatment plan to help with particular symptoms.

In this article, I’ll discuss the diagnosis of BPD and the different classes of medications that may be prescribed.

I’ll explain precautions to take, possible side effects of prescribed medications, and the treatment and recovery processes.

Finally, I’ll explore when to see a doctor or mental health professional.

Diagnosis

The first step in treating BPD is a correct diagnosis.

There is no laboratory test to confirm whether a person has the condition.

Only a psychological evaluation by a doctor or mental health provider can diagnose BPD. 

To diagnose a patient, a medical provider will discuss the person’s medical history and symptoms.

The provider may also use questionnaires or interview other medical providers who have treated the patient.

Some of the symptoms a provider will look for include:

• Poor self-image
• Impulsive, self-destructive behavior
• Feeling empty
• Suicidal attempts
• Chaotic interpersonal relationships
• Fear of abandonment
• Repeated, rapid mood swings
• Self-mutilation

People who do not have BPD may at some points in their lives have any one of these symptoms.

But people with BPD typically experience extreme forms of many of these symptoms, and the symptoms typically occur during the same timeframe.

Sometimes questionnaires to assess for psychiatric conditions may inaccurately label people with BPD as having bipolar disorder.

BPD often co-exists with anxiety disorders, depression, eating disorders, and substance abuse.

The symptoms of these other conditions may interfere with a proper diagnosis.

Care must be taken to rule out these conditions or acknowledge that they can happen simultaneously.  

Medications for Borderline Personality Disorder

Medicines can help manage severe BPD symptoms such as anxiety and depression, and possibly treat coexisting conditions.

However, medication is never a standalone treatment option for BPD and is typically used alongside psychotherapy.

The drugs used to treat BPD are used off-label since no drug is approved by the Food and Drug Administration (FDA) for specifically treating the condition.

The following drug classes are frequently prescribed.

Antidepressants

Major depressive disorder is a mental health condition that frequently coexists with BPD.

Antidepressants are often prescribed to help alleviate the symptoms of depression, such as low mood, sadness, and anxiety.

There are several studies on the effectiveness of antidepressants for treating BPD.

Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), can help improve depression symptoms associated with BPD.

And the tricyclic antidepressant amitriptyline showed improvements in symptoms of BPD that were not related to major depression.

However, other options are often tried first since tricyclic antidepressants can have serious side effects.

Antipsychotics

Antipsychotics may help to reduce hostility, impulsivity, and rapid and intense mood swings typical of BPD.

Mental health professionals usually prescribe second-generation antipsychotics because, compared with first-generation antipsychotics, these medications have less risk of severe side effects like movement disorders.

Examples of second-generation antipsychotics include olanzapine, risperidone, cariprazine, ziprasidone, and paliperidone.

Side effects of taking antipsychotics include dry mouth, dizziness, fatigue, blurred vision, and weight gain (which can lead to diabetes).

Anticonvulsants

People with BPD usually experience rapid mood swings and feelings of self-harm similar to those experienced by people with bipolar disorder.

To improve these symptoms, a medical provider may prescribe anticonvulsants, as these are effective treatments for bipolar disorder.

These act as mood stabilizers and may help improve impulse control and aggression.

Possible side effects of anticonvulsants include nausea, fatigue, and feelings of slowed or fuzzy thinking.

Anxiolytics

People with BPD can experience episodes of severe anxiety.

Anxiolytics, also known as anti-anxiety or anti-panic drugs, are often prescribed to reduce the anxiety that can accompany BPD.

Common anxiolytics that may be prescribed include selective serotonin reuptake inhibitors (SSRIs) like sertraline (Zoloft) and fluoxetine (Prozac), buspirone (Buspar), and benzodiazepines such as alprazolam (Xanax) or clonazepam (Klonopin). 

Benzodiazepines can be habit-forming.

Your mental health provider can help you determine the correct medication for anxiety associated with BPD. 

Precautions 

There are certain precautions with the use of these different classes of medication:

• Benzodiazepines such as lorazepam and diazepam can be habit-forming, so they are not suitable for people with BPD who have a history of substance abuse.

• Benzodiazepines may increase impulsivity and risks of suicide.

• Though effective, amitriptyline has limited use because it is severely toxic if overdosed. This poses a risk to individuals with BPD and impulsive feelings to self-harm.

Your psychiatrist or mental health provider will help you decide if the benefit of a certain drug outweighs any risk before prescribing it.

They may also suggest alternative medication or treatment. 

Side effects to look out for

People with BPD may have to take more than one medicine to treat their symptoms.

Each of these medications may have side effects.

Common side effects of BPD medications include:

• Fatigue
• Dizziness
• Headache
• Confusion
• Vision problem
• Changes in behavior
• Uncontrollable muscle movement
• Seizures

This is not an exhaustive list. 

Side effects can range from mild to severe.

If side effects impact your daily life, speak to your doctor.

Do not discontinue your medication without their help.

Treatment and Recovery

BPD cannot be cured; however, the symptoms can be managed. 

Psychotherapy, also called talk therapy or therapy, is the first treatment option.

Therapy involves talking with a mental health provider to learn about your condition and help manage your mood and other symptoms in a healthy way. K Health offers K Therapy, a text-based therapy program that includes unlimited messaging with a licensed therapist, plus free resources designed by mental health experts to use on your own.

There are several types of therapy, including: 

• Dialectical behavior therapy (DBT): This therapy focuses on emotions and interpersonal relationships. During the sessions, the therapist teaches skills that help individuals navigate difficult emotions.

• Schema-focused therapy: Schema-focused therapy helps to reshape a person’s negative thought patterns and behaviors that have been formed by traumatic experiences since childhood. 

• Mentalization-based therapy (MBT): This therapy teaches individuals to understand their mental states and that of those they relate with. It helps improve the interpretation of other people’s thoughts and emotions, helping those with BPD react appropriately to others.

• Transference-focused therapy: In this type of therapy, the affected individual projects their thoughts and feelings on their therapist (a common symptom of BPD). Together, they examine the problematic patterns through situations that arise during sessions.

• Systems training for emotional predictability and problem solving (STEPPS): This is typically a 20-week-long group therapy of about 6-10 people with a focus on learning about BPD and skills to help navigate life. Friends and family members are usually involved. STEPPS also teaches helpful self-care skills such as eating a balanced diet, exercising, and sleeping well.

Therapy may be one-on-one or in a group.

Group therapy may improve interpersonal relationships and social skills and provide support.

Sometimes people with BPD may have to be hospitalized.

This is usually during a crisis where the individual is at risk of harming themselves or others.

Sometimes, hospitalization is voluntary; other times, it is involuntary and based on health care providers’ recommendations.

During the stay, treatment usually includes individual and group therapy as well as medication.

Since BPD is a long-term mental condition, the treatment plan may adjust over time.

Sometimes medication may be recommended to improve a particular symptom at a specific time.

Treatment will include treating any concurring illnesses.

There is no definite timeline for recovery, as people have different needs and circumstances.

However, psychotherapy and medications have been shown to improve the quality of life over time. 

Even with psychotherapy and medication, you may have episodes where your symptoms are heightened. 

When to See a Doctor or Mental Health Professional

BPD is a serious condition that should receive medical attention if it impacts your life and personal relationships.

When you visit your primary healthcare provider, they will typically refer you to a mental health professional. 

People with BPD can be suicidal and may practice self-harm, so they need to receive treatment.

If you experience mild or serious side effects such as nausea, weight gain, sleep issues, dependence, and tardive dyskinesia (involuntary muscle movements of the face, neck, arms, and legs) from using your prescribed medication, seek help immediately. 

If you’re having a mental health emergency, call 911 or go to the nearest emergency room. You can also get free 24/7 support from a suicide and crisis expert by calling or texting 988. If you’d prefer to chat online, you can chat with a suicide and crisis expert by visiting the Lifeline Chat.