Antipsychotics for Borderline Personality Disorder

Antipsychotics for Borderline Personality Disorder September 19, 2019 Tom Merton/OJO Images/Getty Images More in BPD Treatment Diagnosis Living With BPD Related Conditions Your psychiatrist may prescribe antipsychotics for one or more of your borderline personality disorder (BPD) symptoms.   Why Antipsychotics for Borderline Personality Disorder? The term borderline was coined because early psychiatrists believed that the symptoms of BPD were on the border between neurosis and psychosis. For this reason, some of the first medications tested for BPD were antipsychotics. Although we now know that BPD does not share features with psychosis (and is not a psychotic disorder), research has shown that antipsychotic medications may be effective in reducing some of the symptoms of BPD â€" specifically, anger and hostility, intense mood shifts, and cognitive symptoms, like paranoid thinking. That being said, research shows that antipsychotics are not effective in  improving anxiety, depressed mood, and ?impulsivity in BPD. In addition, while the short-term use of antipsychotics may be effective in BPD, the benefit of frequent and long-term use of antipsychotic is controversial. Types of Antipsychotics There are two main types of antipsychotics: typical and atypical. Typical Antipsychotics. Typical antipsychotics are the older variety of antipsychotic medications, known as first-generation antipsychotics. They are less commonly used due to their potential for serious side effects like movement disorders. Some typical antipsychotics are: Haldol (haloperidol)Navane (thiothixene)Stelazine (trifluoperazine) Atypical Antipsychotics. Atypical antipsychotics are the newer generation of antipsychotic medications, and they produce less of the movement related to side-effects. The six atypical antipsychotics are: Zyprexa (olanzapine)Clozaril (clozapine)Seroquel (quetiapine)Abilify (aripiprazole)Geodon (ziprasidone)Risperdal (risperidone) Side Effects of Antipsychotics Tardive dyskinesia, a side effect that can occur from the long-term use of antipsychotics, involves uncontrollable movements of the face, lips, tongue, limbs, and fingers. Its irreversible, and the risk of developing it is higher with the typical antipsychotics than the atypical antipsychotics. Other potential side effects are called extrapyramidal symptoms, like akathisia, an intense sense of restlessness and agitation. Extrapyramidal symptoms are also more common with the typical than the atypical antipsychotics.  Neuroleptic malignant syndrome  is a rare but very serious condition associated with antipsychotics involving high fever, delirium, and muscle rigidity. While  the atypical antipsychotics are less likely to cause tardive dyskinesia and extrapyramidal symptoms, they are associated with other side effects like weight gain, new onset diabetes, a rise in cholesterol, sexual dysfunction, and heart problems. In addition, some of the individual antipsychotics carry their own unique side effects. For instance, a  rare but potentially fatal side effect of the atypical antipsychotic clozapine is agranulocytosis, a decrease in white blood cells. Regular monitoring of blood counts is required when this agent is used. As shown, there are a number of potential side effects associated with antipsychotics, and they vary by the type (typical vs atypical) of antipsychotic, as well as the individual medication. If your doctor prescribes an antipsychotic, be sure to review the side effects with your doctor and take the medication as directed.   Bottom Line Treating BPD requires an individualized approachâ€"meaning what works for you is likely different from what works for someone else. It will take time for you and your doctor to devise a plan for optimizing your care for your BPD, and this plan may include both medication and psychotherapy. The good news is that there are excellent treatment options available that can help you feel better and get well. A proper discussion and asking the right questions can get you on your way to figuring out the right option for you. Borderline Personality Disorder Discussion Guide Get our printable guide to help you ask the right questions at your next doctors appointment. Download PDF