Wednesday, July 27, 2011

Treatment of Borderline Personality Disorder: Medication

Something that has been on my mind a lot lately. Treatment. So let's take a leap down the rabbit hole and see where treatment for Borderline Personality Disorder takes us.
There are 4 basic strategies that are utilized for treatment of Borderline Personality Disorder: Psychotherapy, Medication, Hospitalization, and Self-Help strategies. Over the next few days I’ll start on the last 3 and then I’ll just take a dive into some of the therapeutic techniques that my therapist specializes in, what we work on, and what is beneficial for Borderline…. And not. Because let’s face it, every person is different, every disorder is different, and some strategies just don’t work well enough on their own to be effective for every case.

Psychotherapy forms the foundation of treatment for borderline personality disorder with medications playing a lesser role. While there is no known medication that can target Borderline Personality Disorder on its own, prescription medications can address many of the common symptoms of BPD. This is something my Psychiatrist told me upon diagnosis. There is no medical cure for Borderline Personality Disorder. However, we can work to manage some of the symptoms and co-morbid occurring issues in order to improve quality of life and aid psychotherapy so that treatment will be successful.
Medications typically used in the treatment of BPD include antidepressants, mood stabilizers, anti-anxiety drugs, and antipsychotics.
 Antidepressants Used for the Treatment of BPD Symptoms
A variety of antidepressants have been studied for use in treating the low moods, sadness, and depression that can occur with BPD, including the following:
-          Fluoxetine (Prozac)** <~~~~ Check
-          Sertraline (Zoloft) <~~~~ Check
-          Citalopram (Celexa)
-          Escitalopram (Lexapro) <~~~~ Check
Mood Stabilizers Used for the Treatment of BPD Symptoms
Medications with mood-stabilizing properties, such as lithium and some anticonvulsant (anti-seizure) medications, can help address the impulsive behavior and rapid emotional changes associated with BPD.
Mood stabilizers used to treat the symptoms of BPD may include:
-          Divalproex sodium (Depakote)
-          Lithium carbonate (Lithobid)
-          Lamotrigine (Lamictal)  <~~~~~~ Check
Anti-anxiety Medications Used for the Treatment of BPD Symptoms
Anti-anxiety (anxiolytic) medications can help with the intense anxiety some people with BPD may experience. However, there isn’t much research that supports the use of anti-anxiety drugs to treat BPD. Some research actually indicates that one class of anti-anxiety drug — benzodiazepines (e.g., Ativan, Klonopin) — may actually worsen BPD symptoms for some people.
Examples of anti-anxiety medications used to treat the symptoms of BPD include:
-          Alprazolam (Xanax) <~~~~~ Check
-          Clonazepam (Klonopin) <~~~~~ Check
-          Lorazepam (Ativan)
-          Diazepam (Valium)
-          Buspirone (Buspar)
Antipsychotic Medications Used for the Treatment of BPD Symptoms
Antipsychotic medications can help address occasional breaks from reality as well as the paranoia, anger, or hostility that people with BPD may experience.
Some antipsychotics used to treat BPD include:
-          Olanzapine (Zyprexa)** <~~~~ Check  
-          Risperidone (Risperdal) <~~~~ Check
-          Aripiprazole (Abilify) <~~~~ Check
-          Haloperidol (Haldol)
-          Paliperidone (Invega)
** Symbyax was the atypical anti-psychotic Psychiatrist had me on. It’s a combination of Olanzapine and fluoxetine.
My medication-go-round has been a bit exhausting. And by a bit, I mean, I am more tired and have less energy now than I have ever had in my life, even in my worst depression. At my lowest point I’m still a very high-functioning person and could at least stick to my routines of get up, go to work, go to the gym, shower, eat, bed. At the very least. I no longer have the energy to go to the gym, which makes me have even less energy to do anything else. I have begun to lose my motivation for the things I love. I just feel weighed down by everything. The weather has even cooled down a little so there’s no attributing it to the heat. My only conclusion is that it’s the medication because, surprise, that’s when I started to feel so off.
I understand why Psychiatrist put me on the Symbyax even though it ended up exacerbating my eating disorder. I was harming myself and bordering on suicidal and he wanted something that would help me immediately. Unfortunately this was not good for me in the long run. The Lamictal didn’t work at all. Because of the issues with the Symbyax I’m afraid of anti-psychotics but agreed to the Abilify.

I do feel a little more stable, but I also feel deadened and weighed down. Nothing is as fun, nothing is as beautiful, being with people is not as enjoyable, I don’t feel love and I can’t get swept away. This is not the kind of stability I’m looking for. I’m constantly fatigued. Getting out of bed and sitting upright are a chore. I’m losing my desire to do things I love. I look forward to the day ending so I can sleep. Then when I wake up all I want to do is continue sleeping. This. Is not me.  This has never been me. I refuse to accept that this is how I should be. Friend once told me that the meds might just be making me ‘normal’, “now you’re just not a superwoman, you have a normal person’s energy, you’ll get used to it”. If this is the energy level that normal people have than no wonder our country is so slow. I hate it. I am not a slow person. I think sometimes they like me on these meds because they don’t feel so bad being lazy themselves. The meds are bringing me down to their level and it makes them feel better about their own short comings. Screw that. Or I’m paranoid. (indicator of meds not working? Eh?) Whatever.
I’d rather be a little crazy but fully functional, then mostly ‘normal’ and utterly immobile.
I’m going to talk to Psychiatrist tomorrow about going off medication. At least for the rest of the summer. Give it a trial run. See if my energy ramps back up. If it does, then it’s definitely the medication that’s slowing me down and I’ll know. Which means what I’m on is not ok for me. If I continue to feel this way off the medication than there’s something else going on and I may have to go back to two sessions of therapy a week to work on stuff. It’s a process. I’m still open to the possibility of medication, but right now I feel I need to reestablish my baseline and get myself back to a healthy normal for my body. The funny thing about taking care of your body, your mind usually follows….

6 comments:

  1. I often wonder what my energy levels would be like without the medication. It's been so many years since I was medication-free, I'm kind of used to being exhausted/fatigued. Stick to your guns and get some time off the meds, will be interesting to see if your energy returns.

    Great post as always.

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  2. do you ever think the meds are killing the "real" you (would i have don this w/o meds? curing not only the ba but also the good)

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    1. It totally depends on the medication. I was on Symbyax and Abilify at various points and those absolutely killed the "real" me. They zapped me of all my energy. I no longer cared about anything. I felt like a zombie of fatigue. Absolutely horrible. Just sitting up was hard.

      I took Lexapro for a while and I felt like me, happier, but there were some side effects that I wasn't ok with.


      The Lamictal did absolutely nothing for me. I felt no change whatsoever.

      The Pristiq that I'm now, I love. I feel 100% like my normal self. I'm just not as depressed as usual. So I feel 100% like my normal self except I'm not as anxious and depressed! Which is exactly how you would hope these meds are supposed to work.


      I'm extremely wary, even terrified, of taking anti-psychotics because of all the side effects. SSRIs don't seem to work properly for me. The Pristiq is an SNRI and I love it. It's all about finding the right med and treatment for you.


      Antipsychotics are "mood stabilizers" but since I'm also Major Depressive "stabilizing" my mood means I might not have as many mood swings, but I'll also be depressed all the time. That's why I asked to just be put on an anti-depressant to help lift my mood, while I work on my mood swings in therapy and through other constructive outlets.

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  3. I also am borderline and am sick of the trial and error. Sooo tired.I just want to feel like my normal self. To get up and take showers. I'm getting off effexor and on getting on lamictal. I also take neurontin and klonopin. I read 'loud in the house of myself' and she said lamical helped her the best. My dr said subliquel. B12 can help with my energy. I need it. Work is fast paced and I have to fake pleasantness. I'm trying over the counter speed to help. I'm at a loss. I don't what to do.

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    Replies
    1. I know exactly how you feel. The trial and error of medications is exhausting. Try to be patient, as hard as that is.

      I tried lamictal for a while and it didn't do anything for me. I hope you have been luck. I definitely agree with the B12. I always take a B-Complex vitamin because it really does help.

      Good luck!

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  4. How was your experience with Prozac? I read about this approach on the BPD that used higher doses (80 mg) of Prozac and it seems is working out well for some people . One of the psichiatrist who recommends that is called Lelland Heller, he's got an website called biological unhappiness

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