Your psychiatrist may prescribe antipsychotics for your borderline personality disorder (BPD) symptoms. Antipsychotic medications can have a positive effect on a variety of non-psychotic disorders, including BPD.
Why Antipsychotics for Borderline Personality Disorder?
The term "borderline" was coined because early psychiatrists believed that the symptoms of BPD were "on the border" between neurosis and psychosis. For this reason, some of the first medications tested for BPD were antipsychotics.
Although we now know that BPD does not share features with psychosis, research has shown that antipsychotic medication can be effective in reducing some of the symptoms of BPD. Specifically, antipsychotics have been shown to reduce anxiety, paranoid thinking, anger/hostility, and impulsivity in patients with BPD.
Types of Antipsychotics
There are two main types of antipsychotics: typical and atypical.
Typical Antipsychotics. Typical antipsychotics are the older variety of antipsychotic medications. While these types of medications are still in use, they are generally used for very short-term treatment. Longer-term use of typical antipsychotics can lead to some very serious side effects, so they are not a first line treatment for BPD symptoms. Some common typical antipsychotics are:
Atypical Antipsychotics. Atypical antipsychotics are the newer generation of antipsychotic medications; these tend to produce less of the movement related side-effects such as akathesia and tardive dyskinesia (discussed below). Some common atypicals are:
- Zyprexa (olanzapine)
- Clozaril (clozapine)
- Seroquel (quetiapine)
- Abilify (aripiprazole)
- Risperdal (risperidone)
Side Effects of Antipsychotics
Tardive dyskinesia, a side effect that can occur from the long term use of antipsychotics, involves uncontrollable movements of the face, lips, tongue, limbs, and fingers. Antipsychotics can also be responsible for an intense sense of restlessness and agitation called akathisia. Antipsychotics may also cause dry mouth, sedation, sexual dysfunction, and weight gain.
Although the risks of conditions such as tardive dyskinesia with the typical antipsychotics have tended to be emphasized, there is a risk of potentially severe side-effects from any antipsychotic. The atypical antipsychotics are more likely to cause significant weight or metabolic issues, as well as have some risk for the movement related side-effects as well.
A rare but potentially fatal side effect of the atypical antipsychotic clozapine is agranulocytosis, a decrease in white blood cells. Regular monitoring of blood counts is required when this agent is used. Neuroleptic malignant syndrome is a serious condition associated with antipsychotics involving high fever, delirium and muscle rigidity.
Sources
Albers LJ, Hahn RK, & Reist C. Handbook of Psychiatric Drugs, Current Clinical Publishing Strategies, 2008.
American Psychiatric Association. "Practice Guidelines for the Treatment of Patients with Borderline Personality Disorder." American Journal of Psychiatry, 158: 1-52, October 2001.
Triebwasser, J, and Siever, LJ. "Pharmacotherapy of Personality Disorders." Journal of Mental Health, 16: 5-50, February 2007.
