Antipsychotics for the treatment of borderline personality disorder

Your psychiatrist may prescribe antipsychotic drugs for one or more of your borderline personality disorder (BPD) symptoms.

Why do antipsychotics treat borderline personality disorder?

The term “marginal” was coined because early psychiatrists believed that the symptoms of BPD were on the “marginal” between neurosis and psychosis. For this reason, some of the first drugs tested for BPD were antipsychotics.

Although we now know that BPD and psychosis do not share the same characteristics (and are not psychosis), studies have shown that antipsychotic drugs may be effective in reducing some of the symptoms of BPD—especially anger and hostility, strong emotional changes and cognitive symptoms, such as Paranoid thinking.

Having said that, studies have shown that antipsychotics cannot effectively improve anxiety, depression, and impulsivity in BPD. In addition, although short-term use of antipsychotics may be effective for BPD, the benefits of frequent and long-term use of antipsychotics are controversial.

Types of antipsychotics

There are two main types of antipsychotics: typical and atypical.

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Typical antipsychotic drugs. Typical antipsychotics are older antipsychotics, called first-generation antipsychotics. They are not commonly used because they may cause serious side effects such as movement disorders. Some typical antipsychotics are:

  • Haldol (Haloperidol)
  • Navane (thiophene thiophene)
  • Strazine (Trifluoperazine)

Atypical antipsychotics. Atypical antipsychotics are a new generation of antipsychotics that produce less exercise related to side effects. Atypical antipsychotics include:

  • Abilify (aripiprazole)
  • Caplyta (lumateperone)
  • Fanapt (Imperidone)
  • Geodon (ziprasidone)
  • Invega (paliperidone)
  • Latuda (Lurasidone)
  • Rexulti (Bripiprazole)
  • Risperidone (risperidone)
  • Saphris (asenapine)
  • Seroquel (quetiapine)
  • Vraylar (Cariprazine)
  • Zaipule (olanzapine)

Side effects of antipsychotics

Tardive dyskinesia is a possible side effect of long-term use of antipsychotics, involving uncontrollable movements of the face, lips, tongue, limbs, and fingers. This is irreversible, and the risk of using typical antipsychotics is higher than using atypical antipsychotics.

Other potential side effects are called extrapyramidal symptoms, such as akathisia, a strong feeling of restlessness and agitation. Extrapyramidal symptoms are also more common than atypical antipsychotics.

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Antipsychotic malignant syndrome is a rare but very serious disease associated with antipsychotics, including high fever, delirium, and muscle stiffness. The antipsychotic malignant syndrome is also associated with seizures, rhabdomyolysis (the breakdown of muscle that can lead to renal failure), coma, and death.

Although atypical antipsychotics are unlikely to cause tardive dyskinesia and extrapyramidal symptoms, they are associated with other side effects, such as weight gain, new-onset diabetes, elevated cholesterol, sexual dysfunction, and heart problems.

As shown in the figure, antipsychotics have many potential side effects, which vary depending on the type of antipsychotic (typical and atypical) and individual drugs. If your doctor prescribes antipsychotic drugs, be sure to check with your doctor for side effects and take the medication as directed.

Bottom line

Treating BPD requires a personalized approach-which means that what works for you may be different from what works for others. You and your doctor need time to develop a plan to optimize your BPD care, which may include medication and psychotherapy.

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The good news is that there are many excellent treatment options that can help you feel better and recover. Proper discussion and asking the right questions can help you find the right option for you.

Borderline Personality Disorder Discussion Guide

Get our printable guide to help you ask the right questions the next time you see a doctor.