From the Research
There is no single "best" medication to treat Borderline Personality Disorder (BPD) as it's primarily treated with psychotherapy rather than medication, and medication choices should be individualized based on symptom profile, with the most recent and highest quality study suggesting that pharmacotherapies have limited efficacy in reducing the severity of BPD 1.
Medication Options
When considering medication, the following options may be used as adjuncts to psychotherapy:
- Mood stabilizers like lamotrigine (starting at 25mg daily, gradually increasing to 200mg daily) or valproate (starting at 250mg twice daily, titrating based on response) for mood instability
- Atypical antipsychotics such as aripiprazole (2.5-15mg daily) or olanzapine (2.5-10mg daily) for impulsivity and aggression
- Antidepressants like SSRIs (e.g., fluoxetine 20-80mg daily or sertraline 50-200mg daily) for comorbid depression or anxiety
Importance of Psychotherapy
It is essential to note that Dialectical Behavior Therapy (DBT) is considered the gold standard treatment for BPD, and medication should always be used in conjunction with psychotherapy.
Monitoring and Follow-up
Patients should be monitored closely for side effects and therapeutic response, with regular follow-up appointments to assess effectiveness, as the evidence indicates that the efficacy of pharmacotherapies for the treatment of BPD is limited 1.