Patients with borderline personality disorder tend to have strong placebo responses to medication; thus, impressive short-term improvement might occur but then fade unexpectedly. Impulsivity, affective instability, and psychosis are the significant manifestations of borderline pathology that might necessitate pharmacologic treatment.
Selective serotonin reuptake inhibitors (SSRIs) are strongly preferred to the other classes of antidepressants. Benzodiazepines are not recommended because they reduce inhibitions and are therefore likely to increase impulsivity; furthermore, patients with borderline personality disorder are prone to sedative addiction. Risperidone and naltrexone may be considered.
When used at high doses, SSRIs appear to reduce impulsivity and aggression; however, their antidepressant effects are less impressive than those of other drugs. An important advantage of SSRIs is their relative safety; this is especially important because patients with borderline personality disorder commonly overdose on prescribed medication. The use of TCAs, lithium, and other mood stabilizers is usually not indicated without specific relevant symptoms and a strong, ongoing therapeutic relationship.
Because the adverse-effect profile of SSRIs is less prominent, improved compliance is promoted. SSRIs do not have the cardiac arrhythmia risk associated with TCAs. Arrhythmia risk is especially pertinent in overdose, and suicide risk must always be considered in the treatment of a child or adolescent with a mood disorder. SSRIs may also be useful if a patient with borderline personality disorder also develops major depression.
This Fast Five Quiz was excerpted and adapted from the Medscape Drugs & Diseases article Borderline Personality Disorder.
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Cite this: Stephen Soreff. Fast Five Quiz: Borderline Personality Disorder - Medscape - Mar 09, 2021.