back to Main Page     Page updated 7-24-12
 

New studies on Topiramate - go to this link

Medication

Excerpts By Gregory Pacana    7-24-12

There are three classes of medications that are effective in treating patients with borderline personality disorder. They are atypical antipsychotics, mood stabilizers, and certain types of antidepressants.

One class of medications that should generally be avoided when treating patients with borderline disorder are benzodiazepines. These meds are often prescribed to treat the anxiety which affects 9 out of 10 patient with bpd. However, since this class of medication, which includes the drugs xanax and valium, has a high potential for abuse and addiction and should generally be avoided in the case of patients with bpd.

Atypical antipsychotics

These are a newer generation of antipsychotic meds that do not produce the kind of negative side effects of some of the older antipsychotic drugs. These meds when given in small doses have been shown to reduce symptoms such as distorted thinking, paranoia, impulsivity, transient psychosis, anger/aggression, and suicidal thoughts in borderline patients. Included in this family of medication are olanzapine (Zyprexa), aripiprazole (Abilify), and risperidone (Risperdal).

SSRI antidepressants

SSRIs are some of the most commonly prescribed medications in the United States. Medications in this class include drugs like Prozac, Celeza, and Zoloft. There are considered very safe and are effective in reducing both the anxious and depressive symptoms that often accompany borderline personality disorder. These meds have also been shown to be effective in calming borderline anger or rage.

Mood stabilizers

Medications in this class include divalproex (Depakote), lamotrigine (Lamictal),
carbamazepine (Tegretol), and Lithium. In addition to regulating the mood swings which are a common feature in borderline patients, these medications have also been show effective in reducing the anger/hostility and the impulsivity in borderline patients.

Borderline personality disorder is a serious complex psychiatric condition with no known cure. However, with time and long-term talk therapy patients can make significant improvements. In addition medication is now showing greater promise in treating this often devastating disorder.


This discussion is written from a layperson's point of view and non-technical jargon.  A person with Borderline has deficits or difficulties with varying degrees of the following dimensions.  These dimensions are:

1)sensitivity to the environment, affected by norepinephrine
2) mood stability, affected by acetylcholine
3) impulsivity & aggression, affected by serotonin
4) thinking, affected by dopamine

One medication or a cocktail of these medications may be prescribed to the patient with BPD.  They will not all work the same with every patient.  Our bodies respond predominantly the same to like medications, but not always.  Sometimes, prescribing a medication regime for a BPD is a "hit or miss" process, bringing frustration to both the doctor and the patient.  Reading through these entire 2 lists, you will see that there is no medication for the treatment of BPD.  The only treatment is behavior therapy.  These medications are to help the other disorders that often accompany BPD. 

Anti-Anxiety / Sensitivity to Environment

Mood Stabilizers / Mood Stability

Antipsychotics / Impulsivity and Aggression

Antidepressants / Thinking

MORE COMPLETE LIST OF MEDICATIONS USED           ( 8-9-09 )

 

Psychotropic Medications

Listed below are the brand names, followed by the generic in parentheses. Following this chart is a cross-reference by generic name.

Reviewed by Bill Knebel, Pharm.D., Clinical Center, NIH 4/98

SCHIZOPHRENIA

  • TYPICAL ANTIPSYCHOTICS


Haldol (haloperidol), Haldol Decanoate
Loxitane (loxapine)
Mellaril (thioridazine)
Moban (molindone)
Navane (thiothixene)
Prolixin (fluphenazine), Prolixin Decanoate
Serentil (mesoridazine)
Stelazine (trifluoperazine)
Thorazine (chlorpromazine)
Trilafon (perphenazine)
Vesprin (triflupromazine)
 

  • ATYPICAL ANTIPSYCHOTICS

Clozaril (clozapine)
Risperdal (risperidone)
Seroquel (quetiapine)
Zeldox (ziprasidone)
Zyprexa (olanzapine)
 

BIPOLAR DISORDER

Calan (verapamil)
Cibalith-S (lithium citrate)
Depakene (valproic acid)
Depakote (divalproex sodium)
Eskalith (lithium carbonate)
Isoptin (verapamil)
Lithobid (lithium carbonate)
Tegretol (carbamazepine)
Topamax
 

DEPRESSION

  • Tricyclics

Adapin (doxepin)
Anafranil (clomipramine)
Desyrel (trazodone)
Elavil (amitriptyline)
Endep (amitriptyline)
Ludiomil (maprotiline)
Norpramin (desipramine)
Pamelor (nortriptyline)
Sinequan (doxepin)
Surmontil (trimipramine)
Tofranil (imipramine)
Vivactil (protriptyline)
 

  • SSRIs
     

Luvox (fluvoxamine)
Paxil (paroxetine)
Prozac (fluoxetine)
Zoloft (sertraline)
 

  • MAOIs
     

    Nardil (phenelzine)
    Parnate (tranylcypromine sulfate)
     

  • Others

Effexor (venlafaxine)
Remeron (mirtazapine)
Serzone (nefazodone)
Wellbutrin (buproprion)
 

PSYCHOTIC DEPRESSION

Asendin (amoxapine)

ATTENTION DEFICIT DISORDER

Adderall (amphetamine; dextroamphetamine)
Cylert (pemoline)
Dexedrine (dextroamphetamine)
Norpramin (desipramine)
Ritalin (methylphenidate)
Wellbutrin (buproprion)

ANXIETY

Ativan (lorazepam)
BuSpar (buspirone)
Centrax (prazepam)
Klonopin (clonazepam)
Librium (chlordiazepoxide)
Serax (oxazepam)
Tranxene (clorazepate)
Valium (diazepam)
Xanax (alprazolam)

OBSESSIVE COMPULSIVE DISORDER

Anafranil (clomipramine)
Luvox (fluvoxamine)
Paxil (paroxetine)
Prozac (fluoxetine)
Zoloft (sertraline)

PANIC

Paxil (paroxetine)
Prozac (fluoxetine)
Tofranil (imipramine)
Xanax (alprazolam)
Zoloft (sertraline)


Generic Name
Brand Name
Current Uses

alprazolam
Xanax
anxiety, panic
 

amitriptyline
Elavil, Endep
depression (tricyclic)
 

amoxapine
Asendin
psychotic depression
 

amphetamine;
Adderall
ADD
 

buproprion
Wellbutrin
depression, ADD
 

buspirone
BuSpar
anxiety
 

carbamazepine
Tegretol
bipolar disorder
 

chlordiazepoxide
Librium
anxiety
 

chlorpromazine
Thorazine
schizophrenia (typical)
 

clomipramine
Anafranil
OCD, depression (tricyclic)
 

clonazepam
Klonopin
anxiety
 

clorazepate
Tranxene
anxiety
 

clozapine
Clozaril
schizophrenia (atypical)
 

desipramine
Norpramin
depression (tricyclic), ADD
 

dextroamphetamine
Adderall, Dexedrine
ADD
 

diazepam
Valium
anxiety
 

divalproex sodium
Depakote
bipolar disorder
 

doxepin
Adapin, Sinequan
depression (tricyclic)
 

fluoxetine
Prozac
depression (SSRI), OCD, panic
 

fluphenazine
Prolixin, Prolixin Decanoate
schizophrenia (typical)

fluvoxamine
Luvox
OCD, depression (SSRI)
 

haloperidol
Haldol, Haldol Decanoate
schizophrenia (typical)
 

imipramine
Tofranil
depression (tricyclic), panic
 

lithium carbonate
Eskalith, Lithobid
bipolar disorder
 

lithium citrate
Cibalith-S
bipolar disorder
 

lorazepam
Ativan
anxiety
 

loxapine
Loxitane
schizophrenia (typical)
 

maprotiline
Ludiomil
depression (tricyclic)
 

mesoridazine
Serentil
schizophrenia (typical)
 

methylphenidate
Ritalin
ADD
 

mirtazapine
Remeron
depression
 

molindone
Moban
schizophrenia (typical)
 

nefazodone
Serzone
depression
 

nortriptyline
Pamelor
depression (tricyclic)
 

olanzapine
Zyprexa
schizophrenia (atypical)
 

oxazepam
Serax
anxiety
 

paroxetine
Paxil
depression (SSRI), OCD, panic
 

pemoline
Cylert
ADD
 

perphenazine
Trilafon
schizophrenia (typical)
 

phenelzine
Nardil
depression (MAOI)
 

prazepam
Centrax
anxiety
 

prochlorperazine
Compazine
schizophrenia (typical)
 

protriptyline
Vivactil
depression (tricyclic)
 

quetiapine
Seroquel
schizophrenia (atypical)
 

risperidone
Risperdal
schizophrenia (atypical)
 

sertraline
Zoloft
depression (SSRI), OCD, panic
 

thioridazine
Mellaril
schizophrenia (typical)
 

thiothixene
Navane
schizophrenia (typical)
 

tranylcypromine sulfate
Parnate
depression (MAOI)
 

trazodone
Desyrel
depression (tricyclic)
 

trifluoperazine
Stelazine, Vesprin
schizophrenia (typical)
 

trimipramine
Surmontil
depression (tricyclic)
 

valproic acid
Depakene
bipolar disorder
 

venlafaxine
Effexor
depression
 

verapamil
Calan, Isoptin
bipolar disorder
 

ziprasidone
Zeldox
schizophrenia (atypical)
 

(The above list provided courtesy of NAMI (National Alliance for the Mentally Ill)

Borderline Personality Disorder & Topiramate      (10-13-09)
 
    excerpt by Dr. Pierre M Joubert

Relatively small and brief randomised, placebo-controlled studies indicate that Topiramate may be useful for treating borderline personality disorder (BPD) at dosages of 200 mg per day (that were titrated upwards from 25 mg per day). Loew et al.25 studied 56 patients over a 10-week period with promising results. Nickel et al.26 studied 29 women with BPD and found significant reductions in anger measurements. Nickel et al.27 repeated the study with 42 male subjects suffering from BPD, with similar results. In both the Nickel et al. studies, the dosages were 250 mg per day after titration upwards from 50 mg per day.

Do Prado-Lima et al.28 reported a case study of a woman with BPD who responded to Topiramate. Cassano et al.29 described a 24-year-old woman with bipolar II disorder and BPD who was treated with Topiramate in the course of trying to find a drug that controlled her depression; self-mutilation ceased after 2 weeks on 200 mg per day, despite no improvement of her depression. After Topiramate had been discontinued, self-mutilation recurred, but ceased again after re-introducing the Topiramate.

Anger, Aggression and Self-injury

Gobbi et al.    30 reported on a retrospective, case-controlled, mirrorimage study involving 45 inpatients with marked aggression and agitation who were managed in a maximum-security Canadian psychiatric hospital. The patients were suffering from schizophrenia, schizo-affective disorder and bipolar disorder.  The authors compared sodium valproate, Topiramate and a combination thereof. Both valproate and Topiramate reduced aggression, but only valproate reduced agitation. They suggested that Topiramate might be useful in the treatment of aggression in psychosis, calling for double-blind randomised, placebo-controlled studies.

Nickel et al.31 studied the effects of Topiramate on symptoms of anger in women with recurrent major depressive disorder of a mild to moderate degree of severity. They used a randomised, double-blind, placebo-controlled design involving 64 subjects over a 10-week period. They concluded that Topiramate appeared to reduce depressive symptoms and anger. The reduction in anger symptoms was strongly correlated with a reduction in Hamilton Depression Rating Scale scores. The study reported a significant improvement in both depressive symptoms and anger, as well as a correlation between the two. It is however not clear whether the anger improved owing to a selective effect of Topiramate on anger or owing to the improvement in the depressive disorder.

Top