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. 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. Atypical antipsychotics include:
Abilify (aripiprazole) Caplyta (lumateperone) Fanapt (iloperidone) Geodon (ziprasidone) Invega (paliperidone) Latuda (lurasidone) Rexulti (brexipiprazole) Risperdal (risperidone) Saphris (asenapine) Seroquel (quetiapine) Vraylar (cariprazine) Zyprexa (olanzapine)
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. It’s 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. Neuroleptic malignant syndrome is also associated with seizures, rhabdomyolysis (muscle breakdown that can lead to kidney failure), coma, and death. 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 approach—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. There was an error. Please try again.
