While psychotherapy is considered the most important form of treatment for borderline personality disorder (BPD), many people are prescribed medications such as mood stabilizers for BPD. No medication is FDA approved to treat BPD, but some medications with mood stabilizing properties have proven to be effective in reducing some of the symptoms.
It has become increasingly common for psychiatrists to prescribe mood stabilizers for BPD, and there is some evidence that these medications can be effective in reducing some of the emotion dysregulation and impulsivity symptoms of the disorder in particular.
What Are Mood Stabilizers?
The term “mood stabilizer” is used to describe any medication that reduces intense mood shifts or lability.
There are different types of medications that have these properties. For example, a number of medications that were originally developed to treat seizures, called “anticonvulsants,” have mood stabilizing properties. Some examples include:
- Tegretol (carbamazepine)
- Lamictal (lamotrigine)
- Trileptal (oxcarbazepine)
- Topamax (topiramate)
- Depakote (valproic acid, divalproex sodium)
Lithium, a type of salt, is a non-convulsant mood stabilizer that has been a mainstay of treatment for bipolar disorder for years.
- Lithobid (lithium carbonate)
Mood Stabilizers for BPD - Are They Effective?
There is some limited research evidence that mood stabilizers are effective in treating BPD symptoms. The medication that has been most studied is lithium, but the majority of these studies have focused on treatment of impulsivity, so we don’t know how well lithium treats emotional instability in BPD.
Unfortunately, there is even less evidence of the effectiveness of anticonvulsant mood stabilizers. However, published case reports and a few small studies do suggest that these medications may be helpful in treating mood and emotional symptoms in BPD. More research is being conducted now.
Risks and Side Effects of Mood Stabilizers for BPD
Risks and side effects for mood stabilizers can vary depending on the type of mood stabilizer you are taking.
Lithium carbonate can cause gastrointestinal distress (e.g., nausea, vomiting), weight gain, acne, tremors (shaking), and cognitive problems (e.g., feeling like your thinking is slowed or fuzzy). Lithium use also can effect your kidneys and thyroid gland, so blood tests will be required to monitor these functions when you take the medicine. Finally, lithium can be very toxic in high doses, so there can be concerns about prescribing it to people with BPD who have a history of suicidality.
Although each anticonvulsant mood stabilizer has its own unique side effect profile, some possible side effects include gastrointestinal complaints, weight gain, rashes, fatigue, and dizziness. In addition, some of these medications create the risk of serious but rare side effects. For example, individuals taking carbamazepine must be monitored for the development of agranulocytosis, a rare condition marked by a significant decrease in white blood cells in the bloodstream. Toxicity is also a concern in some anticonvulsant mood stabilizers.
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.