Medicines and BPD
Many people with borderline personality disorder are offered medicines, so it helps to know what the research shows. Here is what the National Institute of Mental Health, the American Psychiatric Association, a Cochrane review, and clinical guidance from England say.
Talk to your provider before starting, stopping, or changing any medicine.
If you or someone you know is having thoughts of suicide, call or text 988 or chat at 988lifeline.org. In a life-threatening situation, call 911.
The evidence
What research shows about medicines for BPD
No medicine is approved by the U.S. Food and Drug Administration (FDA) for borderline personality disorder (BPD). Medicines prescribed for it are used off-label, meaning for a purpose they are not approved for.
A 2022 Cochrane review of 46 randomized trials with 2,769 people found that, compared with placebo, antipsychotics, antidepressants, and mood stabilizers made little to no difference to BPD severity, self-harm, suicide-related outcomes, or daily functioning. Most of this evidence was rated very low certainty.
The same review found low-certainty evidence that antipsychotics and mood stabilizers may slightly reduce problems in relationships. Its authors concluded that no medicine seems effective for treating BPD itself.
The American Psychiatric Association (APA) found no evidence that any medicine treats the core symptoms of BPD, and wrote its recommendations to limit taking many medicines at once and staying on them for a long time.
The National Institute of Mental Health (NIMH) says the benefits of medicine for BPD are unclear and that it is not a first-line treatment. Psychotherapy is the main treatment.
National Institute of Mental Health · Borderline personality disorder (brochure)
When medicine may help
How medicines are used, if at all
A provider may recommend a medicine as an add-on to psychotherapy to treat specific symptoms, such as mood swings, or a co-occurring condition, such as depression. This may require coordinated care from more than one provider.
National Institute of Mental Health · Borderline personality disorder (brochure)
The APA suggests that any medicine be time-limited, aimed at a specific symptom that can be measured, and added to psychotherapy rather than used instead of it.
Guidance from England's National Institute for Health and Care Excellence (NICE) says medicines should not be used specifically for BPD or its individual symptoms, such as repeated self-harm or emotional instability, but may be part of treating another condition. It advises treating co-occurring depression, post-traumatic stress disorder (PTSD), or anxiety within a structured BPD treatment program.
NICE also says antipsychotics should not be used for medium- or long-term treatment of BPD.
During a crisis, NICE says a short course of a sedating medicine may be considered cautiously, using a single medicine and planning to stop it, usually within 1 week. A crisis plan and crisis support come first: you can call or text 988 at any time.
Before starting
What should happen before a new medicine
The APA recommends reviewing other conditions you have, past and current therapy, other non-medicine treatments, past medicine trials, and your current medicines before starting anything new.
NICE says you should get written information about the medicine being considered, including the evidence for it in BPD and any other condition and its potential harms, and a chance to talk it through so you can make an informed choice.
Medicines can cause side effects in some people. Ask the provider what to expect.
National Institute of Mental Health · Borderline personality disorder (brochure)
Medicines affect people differently, and it may take several tries to find one that works best with the fewest side effects.
National Institute of Mental Health · Mental health medications
Children, teenagers, and young adults under 25 may have more suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks or after a dose change. People of all ages starting an antidepressant should be watched closely in the first few weeks.
National Institute of Mental Health · Mental health medications
Review regularly
Reviewing, reducing, and stopping medicines
The APA recommends reviewing all medicines at least every 6 months to check whether they are working and to find any that should be tapered or stopped.
NICE advises reviewing the medicines of people with BPD who do not have another diagnosed mental or physical illness, with the aim of reducing and stopping unnecessary ones.
People with BPD often receive several psychiatric medicines at the same time for long periods, the 2022 Cochrane review found, despite the limited evidence.
Do not stop a prescribed medicine without the help of a provider, even if you feel better. A provider can lower the dose slowly and safely, and stopping too soon can cause unpleasant or harmful effects.
National Institute of Mental Health · Mental health medications
For your next visit
Questions to ask
- 1.What specific symptom or condition is this medicine meant to help, and how will we measure it?Based on: American Psychiatric Association · Updated borderline personality disorder practice guideline (news release, Dec 10, 2024)
- 2.What is the evidence that it helps with that, and what harms or side effects are possible?Based on: National Institute for Health and Care Excellence · Borderline personality disorder: recognition and management (CG78) recommendations
- 3.How long should I try it, and when will we review whether it is working?Based on: American Psychiatric Association · Updated borderline personality disorder practice guideline (news release, Dec 10, 2024)
- 4.How does it fit with my therapy?Based on: American Psychiatric Association · Updated borderline personality disorder practice guideline (news release, Dec 10, 2024)
- 5.Could it interact with my other medicines, alcohol, or drugs?Based on: National Institute for Health and Care Excellence · Borderline personality disorder: recognition and management (CG78) recommendations
- 6.If it does not help, will we stop it, and how do I stop safely?Based on: National Institute of Mental Health · Mental health medications
- 7.Are there medicines I take now that I may no longer need?Based on: National Institute for Health and Care Excellence · Borderline personality disorder: recognition and management (CG78) recommendations
Keep going
Plan the conversation with your provider
See the glossary for any word you are not sure about.