Post by Mel on Jan 15, 2006 23:04:01 GMT -5
Update on Medications for Borderline Personality Disorder by Paul Markvoitz, M.D., Ph.D.
It has been a few years since I last contributed to this forum. Since that time there have been a few studies completed that are worth mentioning to help those with borderline personality disorder (BPD). No new drug- type has been released to the market, so do not expect a miracle cure. The studies that have been published all involve medications already on the market that have been better investigated in BPD. In my experience, Effexor XR and Serzone are still the best first line medications, with SRIs (Prozac, Zoloft, Celexa, Luvox, and Paxil) a close second. These medications, however, do not work for everyone, and sometimes are only partially effective so the alternatives are briefly discussed below.
Atypical Antipsychotics
The atypical antipsychotics include Risperdal, Seroquel, Zyprexa, Clozaril, Geodon, and Abilify. All of the aforementioned medications are approved by the FDA for treating schizophrenia. Some of them have been shown to be effective in mania. Zyprexa, Seroquel, and Risperdal all have been shown to help some people with BPD. Zyprexa has been the best investigated, and works fairly well to decrease mood swings, depression, anxiety, and self-injury in BPD. Reports in the literature also give examples of where Risperdal and Seroquel help some people with BPD a great deal. While Zyprexa is the best studied, it does cause a great deal of weight gain, and this may be a negative for its use. The weight gain can be so significant that the risk of developing type II diabetes goes way up, and the FDA has clamped a warning label on the atypical antipsychotics for this reason. Clozaril and Zyprexa seem to be the worse agents for causing this. Geodon and Abilify have little to no chance of causing the problem. This is something to consider when discussing medications with your physician. All the atypicals cause sedation for some folks, and mental slowing, tremor, lethargy, and feeling a lack of motivation or joy, are possible. All of those side effects do not usually occur for most people trying the medications. The atypicals really are different in their modes of action, and failing one does not necessarily mean you will fail another. If I were treating someone, I would try to minimize the potential risks to the patient. If you do have any input with your doctor, using Abilify or Geodon first will decrease your chances of the above side effects. Try them all if your doctor thinks they might help. I have had some of my patients not benefit from Abilify but feel well on Zyprexa with almost no side effects.
Anticonvulsants
Lamictal, Topamax, and Depakote have all been shown to help some folks with BPD. Most likely, Trileptal, Zonegan, Neurontin, and Gabitril will also help patients with BPD. The idea for using these arises from the efficacy of anticonvulsants in treating bipolar patients. Investigators reasoned that the mood swings in borderlines might be similar to the mood swings in bipolars. These drugs clearly help some patients, but the do not seem to do much for treating depression when it arises. Like the atypicals, one of these agents may “fit better” in you than another, so there is no right one to use. Side effects are the main determinant in choosing where to start. They all cause some mental dulling, but Gabitril causes the least amount of this problem. Neurontin and Depakote seem to cause the most weight gain. Topamax may actually cause weight loss, Lamictal, Zonegran, and Gabitril seem to be weight neutral. Again, it is a matter of how they fit you, and they are different drugs with different side effects.
Omega-3 Fatty Acid
A study from Boston suggested this over the counter supplement could help some patients. The data presented showed little separation from placebo, but some folks benefited in depression and aggression reduction. It is a fairly cheap supplement, can be added onto your medications that primarily treat BPD, and definitely is good for your heart even if it does not treat the BPD. Do not look for this supplement to replace what you are getting from your doctor. It may help further reduce symptoms, and is definitely worth a try.
Naltrexone
This medication is usually used to unbind heroin or other opiates from your brain if you overdose so you do not die. A few case reports indicate that it helped some individuals with self-injury a great deal. In one report it worked as a stand-alone treatment for the BPD. It has no side effects of note except it is expensive. If you are taking any kind of opiate for pain control (Tylenol #3, Norco, Percocet, etc.) this is not the medication for you. If you are not using any type of opiate and have self-injury, you may want to discuss this medication with your doctor.
Sorry there is so little to report, but our current biological interventions have not changed much for the past 4 years, so there is not much new under the sun. A host of new agents are under investigation by various companies through the Food and Drug Administration, and some of these show promise based on their neurochemistry. Also on the plus side, the National Institute of Mental Health has formally recognized BPD as an illness that needs aggressive treatment. More research dollars then ever are going into studying causes and treatments for BPD. Ultimately, it is incumbent on the afflicted individuals to do everything possible to minimize the impact of the disease. Avoiding drugs and alcohol, compliance with medications, compliance with therapy, and restraint of impulsivity whenever possible are all important. The illness is not your fault, but ultimately actions taken by you will be your responsibility.
It has been a few years since I last contributed to this forum. Since that time there have been a few studies completed that are worth mentioning to help those with borderline personality disorder (BPD). No new drug- type has been released to the market, so do not expect a miracle cure. The studies that have been published all involve medications already on the market that have been better investigated in BPD. In my experience, Effexor XR and Serzone are still the best first line medications, with SRIs (Prozac, Zoloft, Celexa, Luvox, and Paxil) a close second. These medications, however, do not work for everyone, and sometimes are only partially effective so the alternatives are briefly discussed below.
Atypical Antipsychotics
The atypical antipsychotics include Risperdal, Seroquel, Zyprexa, Clozaril, Geodon, and Abilify. All of the aforementioned medications are approved by the FDA for treating schizophrenia. Some of them have been shown to be effective in mania. Zyprexa, Seroquel, and Risperdal all have been shown to help some people with BPD. Zyprexa has been the best investigated, and works fairly well to decrease mood swings, depression, anxiety, and self-injury in BPD. Reports in the literature also give examples of where Risperdal and Seroquel help some people with BPD a great deal. While Zyprexa is the best studied, it does cause a great deal of weight gain, and this may be a negative for its use. The weight gain can be so significant that the risk of developing type II diabetes goes way up, and the FDA has clamped a warning label on the atypical antipsychotics for this reason. Clozaril and Zyprexa seem to be the worse agents for causing this. Geodon and Abilify have little to no chance of causing the problem. This is something to consider when discussing medications with your physician. All the atypicals cause sedation for some folks, and mental slowing, tremor, lethargy, and feeling a lack of motivation or joy, are possible. All of those side effects do not usually occur for most people trying the medications. The atypicals really are different in their modes of action, and failing one does not necessarily mean you will fail another. If I were treating someone, I would try to minimize the potential risks to the patient. If you do have any input with your doctor, using Abilify or Geodon first will decrease your chances of the above side effects. Try them all if your doctor thinks they might help. I have had some of my patients not benefit from Abilify but feel well on Zyprexa with almost no side effects.
Anticonvulsants
Lamictal, Topamax, and Depakote have all been shown to help some folks with BPD. Most likely, Trileptal, Zonegan, Neurontin, and Gabitril will also help patients with BPD. The idea for using these arises from the efficacy of anticonvulsants in treating bipolar patients. Investigators reasoned that the mood swings in borderlines might be similar to the mood swings in bipolars. These drugs clearly help some patients, but the do not seem to do much for treating depression when it arises. Like the atypicals, one of these agents may “fit better” in you than another, so there is no right one to use. Side effects are the main determinant in choosing where to start. They all cause some mental dulling, but Gabitril causes the least amount of this problem. Neurontin and Depakote seem to cause the most weight gain. Topamax may actually cause weight loss, Lamictal, Zonegran, and Gabitril seem to be weight neutral. Again, it is a matter of how they fit you, and they are different drugs with different side effects.
Omega-3 Fatty Acid
A study from Boston suggested this over the counter supplement could help some patients. The data presented showed little separation from placebo, but some folks benefited in depression and aggression reduction. It is a fairly cheap supplement, can be added onto your medications that primarily treat BPD, and definitely is good for your heart even if it does not treat the BPD. Do not look for this supplement to replace what you are getting from your doctor. It may help further reduce symptoms, and is definitely worth a try.
Naltrexone
This medication is usually used to unbind heroin or other opiates from your brain if you overdose so you do not die. A few case reports indicate that it helped some individuals with self-injury a great deal. In one report it worked as a stand-alone treatment for the BPD. It has no side effects of note except it is expensive. If you are taking any kind of opiate for pain control (Tylenol #3, Norco, Percocet, etc.) this is not the medication for you. If you are not using any type of opiate and have self-injury, you may want to discuss this medication with your doctor.
Sorry there is so little to report, but our current biological interventions have not changed much for the past 4 years, so there is not much new under the sun. A host of new agents are under investigation by various companies through the Food and Drug Administration, and some of these show promise based on their neurochemistry. Also on the plus side, the National Institute of Mental Health has formally recognized BPD as an illness that needs aggressive treatment. More research dollars then ever are going into studying causes and treatments for BPD. Ultimately, it is incumbent on the afflicted individuals to do everything possible to minimize the impact of the disease. Avoiding drugs and alcohol, compliance with medications, compliance with therapy, and restraint of impulsivity whenever possible are all important. The illness is not your fault, but ultimately actions taken by you will be your responsibility.