AAPEL
The borderline personality disorder and medication
(treatment by drugs)
 Introduction:
The borderline disorder is also biological. That is confirmed by many very serious studies (read for example risk of suicide according to serotonin's level)
This means that to recover from this disease, it is necessary to have recourse to necessary drugs (this depends on the individuals) but also make a therapy .
You never should take any medication without medical prescription.
Meme page en Francais / Same page in french
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Summary:
Drugs only  to treat BPD ?
Drugs,for whom, what for, how ?
Which types, classes of drugs ?
How long, will I take medication ?
Review of Pharmacotherapy and effectiveness (American Psychiatric Association - Dec 2OO2)
What they say, efficacy, side effects
Nonexhaustive list of drugs used to treat BPD disorder (with right or not)
Studied BPD's molecules (published studies listing, efficacy)
How about homeopathy ?
Psychopharmacological Treatment Algorithms (American Psychiatric Association - Dec 2OO2)

I would like to make a donation or become a member

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Only drugs to treat BPD ?
I will compare this with a car accident in which a cyclist has two broken legs
The cyclist's recovery will have two stages - If we satisfy with stage 1. Then the medical profession will have restored the theoretical use of its legs to the cyclist. But this one will not be able to cycle, not even to walk. And we could affirm that to repair its legs is useless because after "repair" the person is not able to cycle like it was just after its accident

- Second possibility, it wouldn't come to anybody, the idea to have physical therapy with the cyclist, to sit him on a bicycle whereas its legs are still broken. We would talk about cruelty, trying to cycle one person with broken bones

Well, for the borderline personality disorder it is a little similar.
Patient's recovery will have two stages (which will overlap each other)

- If we only satisfy stage 1: Then the medical profession will have restored "the use of its brain" to the patient. But this one will not be able to have a full and opened life because he will not have learned how to manage its emotions, to have "normal" human relationships with others. In short it will still be prone to the suffering

- Second possibility which would not come in mind from anybody for the cyclist case. It is to begin the traitment by the therapy whereas none of the necessary drugs is administered. The therapy then will look at to obtain behaviors from the patient which its brain cannot implement because of its disease. It is exactly like asking a paralytic to break into a run, it is unnecessarily cruel.
It is for this reason that a psychoanalysis on an untreated (by drugs) borderline patient can be very dangerous, because it can lead the person borderline to become aware of its affliction without providing him any solution. In these cases, suicideis not so far

The summary is thus "don't put the cart before the horse "
Stage 1
- Suitable psychopharmacological Treatment. This treatment is completely different according to patients, for some this can be extremely "light" whereas to others that it will be necessary to use neuroleptic drugs.

then just afterwards
Stage 2
- Behavioral Therapy in order to learn or relearn how to handle emotions.

Conclusion:
It is necessary to have a close cooperation between the specialist who manage the suitable pharmacological treatment and the therapist who makes the behavorial restoration of the patient (this can be the same person). Pharmacological treatment evolving in parallel with the advance of the therapy

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Medication for whom, what for, how ?
It is essential to have a balanced brain electricity so that a therapy can succeed. The drugs will be there to restore this balance.
An unsuited medication that we could describe as "too light", i.e. who would not decrease enough for example the anxiety crises or "too heavy" which would make of the patient a kind of "zombie" would not be good for the patient
It is necessary to keep in mind that a person who suffers from a borderline personality disorder often suffers from additional disorders. That means that the treatment will have to take all these disorders into account and that the symptom X's improvement will not have to be made with the symptom Y's detriment
It is thus very significant to speak to its doctor about how we respond to a medication, that so that the treatment is permanently adapted until recovery.
One of therapy's function is to learn to the patient to "feel" the effect of the drugs in order to anticipate the crises and to adjust the dose by itself (while speaking to the doctor about it)

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Which kind of drugs ?
There are several drug families for the borderline personality disorder borderline

-Selective Serotonin Reuptake Inhibitors (5 oht) SSRI. Serotonin being an essential chemical brain substance

In particular for depression, panic crises
- "traditional" antidepressants MAOI or tricyclic

-Anxiolytics

For anxiety, the panic crises
-Neuroleptics
For schizophrenies, psychoses
- Anti epileptics anticonvulsant, mood stabilizers

- Omega3 acid,(please read study) and Vitamin B12,(please read study)

It should be noted that for each drug family, there are many different molecules.
Some are better appropriate than others according to individuals.
If you feel none desirable effects which cannot be corrected ajusting the dose, your doctor will have the possibility to suggest you another molecule.
For examples for the SSRI (serotonine). With some people Prozac is formidable whereas for others, this drug "knock them". He will then be able to use Zoloft, Celexa, floxyfral or deroxat which all are SSRI but with other molecules.

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How long will I take medication ?
This is a chronic illness like diabetes. Does insulin stop at the end of therapy?
Valerie Porr Taraapd
Therapy is like reeducation, to re-learn how to act, be... So it is essential
But it will not totally suppress, the biological unbalance.
If you have serotonin unbalance, then you will need SSRI all your life, like a diabetic need insulin and you will have a "normal" life like everybody.
All this depends of the symptoms you have without medication
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What they say, efficacy, side effects
SSRI
Lithium  mood stabilizers
Neuroleptics
Anxiolytics
  • "While waiting for medications like SSRI's or mood stabilizers to work, a benzodiazepine like Ativan can assist with anxiety

  • Anxiety in the PD patient may present as a chronic and nonspecific complaint, the "pan-anxiety'' of older description, or as an exaggerated response to a social stressor. The use of benzodiazepines is problematic in the treatment of patients with PD, raising the risk of abuse and even behavioral toxicity. The short-acting benzodiazepine alprazolam has been associated with precipitating serious dyscontrol in one placebo-controlled crossover study of patients with BPD (Gardner & Cowdry, 1985). Abuse potential is significant and tolerance problematic over time. Case reports demonstrate some efficacy in the PD patient for the long half-life benzodiazepine clonazepam, which has anticonvulsant and antigenic properties" (mhsanctuary)
     
  • "Alprazolam : USE UP TO EIGHT MONTHS ONLY! Overdose:  Coma and can be fatal. The habit-forming potential is high. It is possible to become dependent in the first few days" (psyweb)
  • "Lorazepam : The habit-forming potential is high" (psyweb)
  • "Clonazepam : The habit-forming potential is high. If used for antianxiety treatment: This drugs should not be taken for more then four weeks ( Yudofsky, Hales and Ferguson . )" (psyweb)
  • "Meprobamate : The habit-forming potential is very high. This drug should not be taken longer then three weeks" (psyweb)
  • "Prazepam / Flurazepam / Clorazepate : The habit-forming potential is high. It is possible to become dependent in only two weeks. This drugs should not be taken for more then four weeks ( Yudofsky, Hales and Ferguson . )" (psyweb)
  • "Bromazepam : Administration of therapeutic doses of benzodiazepines for 6 weeks or longer can result in physical dependence" (inchem)
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    Nonexhaustive list of drugs used (rightly or wrongly) to treat the BPD disorder
    This list is absolutely not presented to give you the possibility to take medication by yourself
    Not, it has the role to present names of drugs and let you know from which family they are.
    The other goal of this list is to show that it exists many different molecules which have the same function and we are thus not condemned to give up any medication if a particular drug is not successful with us
    Of course these molecules being effective they can have on you some disadvantages such as for example weight increase, but I don't think that this must really intervene in the decision when we know the issues
    "to stop suffering"!
    All rights reserved - to be confirmed
    French

    Laboratory

    Name Other names Molecule  Usage
    Pfizer Zoloft Lustral (UK)
    Serlain (BE)
    Sertraline
    Antidepressant
    Selective Serotonin Reuptake Inhibitors (5HT)
    SSRI

    To depression

    (APA Studies)

    Lundbeck Seropram Celexa (USA)

    Cipramil (GB)

    Citalopram
    Lilly  Prozac Fluxtine (CH) Fluoxetine
    (studies)
    Solvay pharma Floxyfral Faverin (UK)

    Floxyfral (B)(CH)

    Luvox (CA)

    Fluvoxamine
    Smithkline 

    Beecham

    Deroxat Paxil (CA) Paroxetine
    Wyeth lederle Effexor - Venlafaxine
    Antidepressant
    serotonin norepinephrine reuptake inhibitor

    To depression

    (APA Studies)
    Riom Laboratoires Norset Mirtazapine (usa)
    Remeron
    Mirtazapine
    Antidepressant
    Norepinephrine Antagonist Serotonin Antagonist 
    Blocks Pre-synaptic Alpha 2 Adrenergic Receptors .

    To depression

    (APA Studies)
    - - Nardil (USA)(UK) Phenelzine sulfate
    Antidepressant
    MAOI

    To depression

    (APA Studies)
    - - Parnate USA)(UK) Tranylcypromine IMAO
    Merck
    Roche
    Elavil
    Laroxyl
    Amavil (usa)
    Amitid (usa)
    Amitril (usa)
    Triavil (usa)
    Saroten (CH)
    Redomex (B)
    Amitriptyline
    Antidepressant
    Tricyclic

    For depression
    (APA Studies)
    Studies

    Servier Stablon   Tianeptine
    Antidepressant ??

    For depression ??

    Laboratory Name Other names Molecule Usage
    Pharmacia

    Upjohn

    Biogaram

    Xanax

    Alprazolam

    Apotex (CA) Alprazolam
    Study
    Anxiolytic
    .
    Benzodiazepine
    .
    Psycholeptic
    .
    To depression

    (APA Studies)

    Biogaram

    Labo biotherap

    Wyeth lederle

    Lorazepam

    Equitam

    Temesta

    Alzapam (USA)

    Ativan (USA)(GB)

    Loridem (B)

    Serenase (B)

    Lorazepam
    Roche Rivotril Klonopin USA) Clonazepam
    Sanofi
    Ldm santé
    Equanil
    Novalm
    Meprospan (Usa)
    Oasil (CH) Pertranquil (BE)(CH)
    Meprobamate
    Jouveinal Lysanxia Centrax (Usa) (UK)
    Demetrin (CH) 
    Prazepam
    Thomson PDR - Dalmane  Flurazepam
    Roche
    Irex
    Lexomil
    Anxyrex
    Bromiden (B)
    Lexotan (B)
    Lexotanil (CH)
    Lectopam (CA)
    Bromazepam
    Sanofi Tranxene Belseren (B)
    Tranxilium (B)(CH)
    Clorazepate
    Bouchara Nordaz Calmday (B)
    Stilny (B) 
    Vegesan (CH)
    Nordazepam
    pharmaco dependance  - risque modéré (biam)
    Laboratory Name Other names Molecule Usage
    Lilly Zyprexa   Olanzapine
    Anti psychotic
    Neuroleptic
    atypical or new generation
    To schizophrenia

    (APA studies)

    Janssen Risperdal Risperidone 
    Merck Clozapine Clozaril  Clozapine
    - Seroquel (USA)  Quetiapine fumarate
    Synthelabo Solian    Amisulpride 
    - Serdolect (USA)  Sertindole 
    - Zeldox (USA)  Ziprasidone
    - - Zoleptil (USA)  Zotepine 
    Bristol-Myers Squibb Abilify   Aripiprazole 
    Schering Trilifan (no more) Trilafon (USA) Perphenazine
    Anti psychotic
    Neuroleptic

    To schizophrenia

    (APA Studies)

    Specia Terfluzine Stelazine (USA) Trifluoperazine
    Janssen Haldol   Haloperidol
    Novartis Melleril   Thioridazine
    - Navane (USA)  Thiothixene
    Lundbeck Fluanxol    Flupentixol
    Specia Tercian    Cyamemazine 
    Laboratory Name Other names Molecule Usage
    Specia Teralithe Lithium (USA) (UK)

    Camcolit (B)

    Hypnorex (CH)

    Lythane (USA)

    Priadel (B)

    Lithium carbonate
    Anti psychotic

    Mania Hypomania

    Bipolar disorder

    (APA Studies)

    Laboratory Name Other names Molecule Usage
    Novartis

    Merck 

    Tegretol

    Carbamazepine

    Epitol (USA)

    Timonil (CH)

    Carbamazepine Antiepileptic - Anticonvulsant

    To epilepsy

    (APA Studies)

    Janssen Epitomax  Topamax (USA) Topiramate 
    Jouveinal Dilantin 
    Neurontin
      Phenytoin
    Gabapentin
    Sanofi Depakine  Depakene (USA)
    Valprotate
    Valproic acid
    Synthelabo Depakote  Divalproex sodium 
    GlaxoWellcome Lamictal  Lamotrigine 
    Novartis pharma Trileptal  Oxcarbazepine 
    Laboratory Name Other names Molecule  Usage
    Pierre Fabre  Maxepa - Omega 3
    Eicosapentaenoic Acid (EPA)
    Diverse
    - Vitamin B12 - Cyanocobalamin
    For published studies, please read studies page
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    What about HOMEOPATHY ?
    For Denise PhiIpott project coordinator N.C.H. (WWW.HOMEOPATHlC.ORG), there is no study about the subject and Borderline disorder (march 2OO3)
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    Omega 3
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    AAPEL - Back to BPD summary page
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    Warning:
    All the information in this site is aimed at helping people understand a "rather particular" and puzzling kind of disease
    But more especially, to support everyone affected by it, sick or not.  In any case, it is ESSENTIAL to see a therapist who specialises in this field they can confirm or give an alternative diagnosis
    The name of what you’ve got doesn’t matter so much, getting the right treatment for the right patient does
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    last update August 2007
    Copyright AAPELTM federation - All rights reserved
    Author, Alain Tortosa, psychotherapist, founder president of the Aapel
    Non profit organization