While psychotherapy is considered the central aspect of treatment for borderline personality disorder (BPD), many people are prescribed antidepressants for BPD. No medication is FDA approved to treat BPD, but many have proven to be effective in reducing some of the symptoms of BPD.
Antidepressants are one of the most commonly prescribed classes of medications for BPD. While antidepressants alone will not produce a full recovery from BPD, they may help you get your symptoms under enough control that psychotherapy will be more helpful to you.
Antidepressants for BPD may be recommended if you have a comorbid depression or if your psychiatrist expects that they with help with your mood symptoms related to the BPD.
Types of Antidepressants
There are many different types of antidepressants. The most commonly prescribed antidepressants are called "selective serotonin reuptake inhibitors" or SSRIs. These medications work by altering the availability of the neurotransmitter serotonin in your brain. Some examples include:
- Celexa (citalopram)
- Lexapro (escitalopram)
- Prozac (fluoxetine)
- Zoloft (sertraline)
- Paxil (paroxetine)
Other types of antidepressants that are prescribed include the "tricyclics" and the "monoamine oxidase inhibitors," or MAOIs. These medications are older and have more serious side effects, so they are less commonly prescribed.
Some tricyclics include:
- Elavil (amitriptyline)
- Anafranil (clomipramine)
- Tofranil (imipramine)
Some MAOIs include:
- Nardil (phenelzine)
- Parnate (tranylcypromine)
Finally, there are other types of antidepressants that are commonly prescribed, including:
- Wellbutrin (bupropion)
- Cymbalta (duloxetine)
- Effexor (venlafaxine)
Antidepressants for BPD - Are They Effective?
A number of research studies have demonstrated that certain types of antidepressants are effective in treating specific symptoms of BPD. For example, SSRIs can reduce emotional instability, impulsivity, self-harm behaviors, and anger. MAOIs have also been shown to effectively treat emotional instability.There is less consistent evidence that tricyclic antidepressants are helpful for people with BPD. While there is evidence that some people with BPD respond well to this type of antidepressant, one research study found that people with BPD who took tricyclics experienced an increase in suicidal thinking and paranoid ideation.
Risks and Side Effects of Antidepressants
Risks and side effects for antidepressants can vary depending on the type of antidepressant you are taking. SSRIs tend to have the least serious side effects, but can produce effects such as decreased appetite, headaches, insomnia, sedation, and sexual dysfunction.
Tricyclic antidepressants can also produce dry mouth, blurred vision, weight gain, seizures, and heart problems. For those taking MAOIs, certain foods that are high in the amino acid tyramine (e.g., soy sauce, aged cheese) must be avoided due to a risk of severely elevated blood pressure. In addition, there are several types of medications that have serious interactions with MAOIs, so always discuss your current medications with your doctor and pharmacist.
Questions for Your Psychiatrist
You should talk to your psychiatrist before you start taking any type of medication for BPD. If you have any concerns (including some of those discussed above), let him or her know. Make sure you understand the risks and side effects, and be sure to have an in-depth discussion about the reasons you are being prescribed a certain medication. Here are some questions you might want to ask:
- Which symptoms do you expect this medication to address?
- Are there particular risks or side effects I should be watching for?
- How will this medication interact with other medications I am taking?
- How long do I need to take this medication before I start to notice effects?
- How long do you think I'll need to be on this medication?
American Psychiatric Association. "Practice Guidelines for the Treatment of Patients with Borderline Personality Disorder." American Journal of Psychiatry, 158: 1-52, October 2001.
Albers LJ, Hahn RK, & Reist C. Handbook of Psychiatric Drugs, Current Clinical Publishing Strategies, 2008.