Jan 12th 2023
There are no medications specifically approved by the U.S. Food and Drug Administration (FDA) to treat borderline personality disorder (BPD).  However, prescription medications are often used to manage the symptoms that occur with BPD, such as anxiety, sleep problems, depression, aggression, mood swings, impulsivity, or psychotic symptoms.  This includes medications such as antidepressants, antipsychotics, mood stabilizers, and anxiolytics (anxiety medications).
Antidepressant medications can be used to treat anxiety and depression symptoms in patients with BPD. Serotonin reuptake inhibitors (SSRIs) and Monoamine Oxidase Inhibitors (MAOIs) are two common antidepressants studied to treat BPD symptoms.
SSRIs increase the level of serotonin in the brain and are used to treat BPD symptoms such as depression ; sudden, extreme mood changes, both highs, and lows (mood instability); anxiety, inappropriate and excessive anger or rage, impulsiveness; rejection sensitivity, and suicidal thoughts and behaviors. 
Common side effects include dry mouth (xerostomia), sexual problems, sleep problems, changes in weight, anxiety, dizziness, headache, and gastrointestinal issues. 
SSRIs can cause serious side effects such as electrical problems with the heart (QT interval), leading to a dangerous and fatal condition called Torsades de Pointes, an extremely rapid heart rhythm (tachycardia).
SSRIs can also impair the body’s ability to clot (hypercoagulation) and increase the risk of suicidal thoughts and actions in children and adults 25 and younger. 
Three SSRIs that have been shown as effective in treating some symptoms of BPD include:
MAOIs block an enzyme called monoamine oxidase, which plays a role in mood. MAOIs are not considered the first choice in treating mental health disorders, but are often prescribed after other antidepressants fail. This is due to them having an increased risk for dangerous, possibly fatal interactions with certain medications or foods. 
Antipsychotics, as a whole, have been associated with worsening the overall severity of borderline personality disorder.  Antipsychotic medications are frequently used for borderline personality disorder. They may effectively reduce impulsiveness, aggression, anxiety, and psychotic symptoms. 
First generation antipsychotics may improve some BPD symptoms, such as anger and impulsive aggressiveness. They pose risks of extrapyramidal symptoms (drug-induced movement disorder) , tardive dyskinesia (involuntary movements of tongue, lips, face, or body), and the deterioration of day to day functioning. 
Atypical (second generation) antipsychotics tend to have fewer side effects and tend to be more effective at decreasing impulse aggression than first generation antipsychotics.
Psychotic symptoms are thought to be triggered by an overproduction of dopamine, Antipsychotics have been shown to reduce dopamine transmission, which can reduce these symptoms. 
Atypical antipsychotics used to treat BPD symptoms include:
Mood stabilizers and anticonvulsants prescribed to treat BPD symptoms include:
Not all mood stabilizers are safe for pregnant women or of childbearing age due to the risk of congenital disabilities.  You should consult your doctor or health care provider if you plan on becoming pregnant or are currently pregnant or breastfeeding.
Anxiolytics are medications used to treat anxiety and other mental health conditions such as panic disorders and insomnia.  anxiolytic drugs stimulate GABA receptors, which creates calming effects. 
The brain can grow accustomed to anxiety medications, which reduce their effectiveness and may require higher doses or medication changes. Anxiety medications may be misused or abused, which can have life-threatening consequences. 
Benzodiazepines are commonly used to treat anxiety, insomnia, seizures, spastic disorders, and agitation and may be used to treat anxiety in BPD patients. 
However, the use of anxiolytics and sedatives to treat BPD should be closely monitored, since they can cause disinhibition, which can be a problem for people with BPD since they can be impulsive. 
Common benzodiazepines include:
Using benzodiazepines requires well-coordinated and planned treatment approaches, such as using time-limited prescriptions. 
Common side effects of benzodiazepines include :
Benzodiazepines can cause more severe side effects, such as angle-closure glaucoma, caused by intraocular eye pressure, which compresses the optical nerve at the back of the eye.  Benzodiazepines should be used sparingly in pregnant and breastfeeding women, due to some potential risks to the baby. 
Preliminary studies have shown a significant reduction in neuroinflammation after six months and 12 months of treatment. ORY-2001 may reduce cognitive deterioration and normalize genes related to cognitive function, neuroplasticity, and memory.  The first assessment on humans has proven it is safe and well tolerated.
Several types of psychotherapy have been shown as effective in the treatment and management of BPD.
The most effective approaches include:
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