From the Research
There is no single best medication for borderline personality disorder (BPD) as treatment typically involves a combination of psychotherapy and targeted symptom management, with psychotherapy, particularly Dialectical Behavior Therapy (DBT), remaining the cornerstone of BPD treatment. Medications are not FDA-approved specifically for BPD but are prescribed to address particular symptoms.
Treatment Approach
For mood instability, mood stabilizers like lamotrigine (starting at 25mg daily, gradually increasing to 100-200mg daily) or valproate (starting at 250mg twice daily, titrating based on response) may help.
- Key considerations include: + The use of atypical antipsychotics such as aripiprazole (2.5-15mg daily) or olanzapine (2.5-10mg daily) for impulsivity and aggression. + Antidepressants like SSRIs (fluoxetine 20-80mg daily or sertraline 50-200mg daily) may help with comorbid depression or anxiety.
Rationale
These medications work by regulating neurotransmitters like serotonin, dopamine, and GABA that influence mood, impulse control, and emotional regulation, as noted in studies such as 1.
- The most recent and highest quality study, 1, suggests that psychotherapy is the treatment of choice for BPD, with medications serving as adjuncts to address specific symptoms rather than treating the underlying personality disorder itself.
Medication Choices
Medication choices should be individualized based on symptom profile, side effect risks, and patient preferences, taking into account the findings from various studies including 2, 3, 4, and 5.
- It is essential to prioritize the patient's overall well-being and quality of life when making treatment decisions.